Defined LJ, Inc

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

DEFINED LJ, INC

Practice address

2623 N Clark St
Chicago, IL 60614-1524

Phone

(312) 722-6977

NPI assigned

Oct 27, 2021

Organization subpart

No

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

Authorized official

Name

Kenneth Munnerlyn, MD

Title

President

Phone

(773) 730-7374

Specialties & licenses 2

Addresses

Other names 1

• DEFINED LJ, INC Other name

Locations

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

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1497419261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2623 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141524",
            "telephone_number": "123-722-6977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2623 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141524",
            "telephone_number": "312-722-6977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEFINED LJ, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-27",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "MUNNERLYN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-730-7374",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DEFINED LJ, INC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jennifer Rose Defazio, M.D.
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• Aline Bethea Talmage Defiglia, LCSW/MPH/CADC
• Christine Grace Defilippo, MD
• Definition Counseling & Therapy PLLC
• Maya Vallabhaneni Defoe, M.D.
• Regina Therese Defranco
• Megan A Defrates
• Antoinette M Defrenza, PHARMD

• Neurology Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Neurology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; 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.