MEDICARE: JENNIFER REBECCA MASSARELLI M.ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	IEIN174836	IL

General Provider Information

NPI Number	:	1255299806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER REBECCA MASSARELLI M.ED

Provider Business Mailing Address
First Line	:	801 NORMANDY LN
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-3209
Country	:	US
Telephone Number	:	847-309-5366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 WAUKEGAN RD # 209
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-2157
Country	:	US
Telephone Number	:	847-309-5366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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