Provider Demographics
NPI:1467516542
Name:DEBJANI ROY MD SC
Entity Type:Organization
Organization Name:DEBJANI ROY MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBJANI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-952-9330
Mailing Address - Street 1:2101 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4185
Mailing Address - Country:US
Mailing Address - Phone:847-952-9330
Mailing Address - Fax:
Practice Address - Street 1:2101 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 155
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4185
Practice Address - Country:US
Practice Address - Phone:847-952-9330
Practice Address - Fax:847-952-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101102174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208582Medicare ID - Type Unspecified