Healthcare Provider Details

I. General information

NPI: 1750473682
Provider Name (Legal Business Name): REHAB SERVICES STONEY ISLAND, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 E 93RD ST
CHICAGO IL
60619-8004
US

IV. Provider business mailing address

3553 W PETERSON AVE SUITE 300
CHICAGO IL
60659-3200
US

V. Phone/Fax

Practice location:
  • Phone: 773-978-3333
  • Fax: 773-978-3005
Mailing address:
  • Phone: 773-463-1313
  • Fax: 773-463-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK BERGER
Title or Position: CEO
Credential:
Phone: 773-519-0500