=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346290020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMB INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 06/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5962 N ELSTON AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60646-5540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-774-2470
-----------------------------------------------------
Fax | 773-774-2405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5962 N ELSTON AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60646-5540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-774-2470
-----------------------------------------------------
Fax | 773-774-2405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LARRY CHUDNOW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-774-2470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------