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General NPI Number Information
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NPI Number | 1326874942
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Entity Type | Organization
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Legal Business Name | J2SB LLC
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 398 W ARMY TRAIL RD STE 120
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2398
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Country | US
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Telephone | 847-610-5169
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Fax | 847-610-3166
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Provider Business Mailing Address
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Address Line | 398 W ARMY TRAIL RD STE 120
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2398
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Country | US
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Telephone | 847-610-5169
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Fax | 847-610-3166
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Authorized Official
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Title or Position | OWNER
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Name | JIGNESH GANDHI
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Credential |
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Telephone | 847-610-5169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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