NPI Code Detail JSON Logo

1457204463 NPI number — IL SNF PHYSICIANS PLLC

NPI Number: 1457204463
Health Care Provider/Practitioner: IL SNF PHYSICIANS PLLC

Information about “1457204463” NPI (IL SNF PHYSICIANS PLLC) exists in 1457204463 in HTML format HTML  |  1457204463 in plain Text format TXT  |  1457204463 in PDF (Portable Document Format) PDF  |  1457204463 in an XML format XML  formats.

NPI Number : 1457204463 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457204463",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "IL SNF PHYSICIANS PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "48 FROST LN UNIT A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAWRENCE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11559-1806",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "205 PINE POINT DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HIGHLAND PARK",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60035-5334",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "516-862-1600",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/18/2026",
    "LastUpdateDate": "02/18/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GOLDBERG",
    "AuthorizedOfficialFirstName": "ARI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "516-862-1600",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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