Healthcare Provider Details

I. General information

NPI: 1063121887
Provider Name (Legal Business Name): IV DOCTOR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 W RANDOLPH ST STE 233
CHICAGO IL
60661-2218
US

IV. Provider business mailing address

53 W 36TH ST RM 204
NEW YORK NY
10018-7624
US

V. Phone/Fax

Practice location:
  • Phone: 844-843-4836
  • Fax:
Mailing address:
  • Phone: 844-843-4836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ADAM NADELSON
Title or Position: CEO
Credential:
Phone: 844-843-4836