Healthcare Provider Details

I. General information

NPI: 1619756889
Provider Name (Legal Business Name): VACCINE CLINICS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7257 N LINCOLN AVE
LINCOLNWOOD IL
60712-1810
US

IV. Provider business mailing address

7257 N LINCOLN AVE
LINCOLNWOOD IL
60712-1810
US

V. Phone/Fax

Practice location:
  • Phone: 917-275-5134
  • Fax:
Mailing address:
  • Phone: 917-275-5134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDAH KANOWITZ
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 917-275-5134