NPIMap

Organization Active NPI

Elmwood Park Vascular Center LLC

  • Vascular Surgery Physician
  • Elmwood Park, IL
National Provider Identifier
1043731300
Registry record updated Jun 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
ELMWOOD PARK VASCULAR CENTER LLC
Practice address
7230 W North Ave Ste 108
Elmwood Park, IL 60707-4261
Phone
(847) 593-8460
Fax
(224) 246-8042
NPI assigned
Jun 27, 2017
Last updated
Jun 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Flora Katsnelson, MD
Title
Owner/Director
Phone
(847) 257-1244

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X Primary

Addresses

Primary practice location

7230 W North Ave Ste 108
Elmwood Park, IL 60707-4261

Mailing address

304 Wainwright Dr
Northbrook, IL 60062-1900
Phone (847) 257-1244

Other identifiers 1

IdentifierTypeStateIssuer
036113246MedicaidIL

National Provider Directory

National Provider Directory

Locations

7230 W North Ave
Ste 108
Elmwood Park, IL 60707
Phone (847) 593-8616

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498521600000",
    "number": "1043731300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 WAINWRIGHT DR",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621900",
            "telephone_number": "847-257-1244",
            "fax_number": "224-246-8042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7230 W NORTH AVE STE 108",
            "city": "ELMWOOD PARK",
            "state": "IL",
            "postal_code": "607074261",
            "telephone_number": "847-593-8460",
            "fax_number": "224-246-8042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELMWOOD PARK VASCULAR CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-27",
        "last_updated": "2017-06-27",
        "status": "A",
        "authorized_official_last_name": "KATSNELSON",
        "authorized_official_first_name": "FLORA",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "847-257-1244",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036113246",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmwood Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.