Provider Demographics
NPI:1508049149
Name:DR. ANTHONY PENDOLINO, LLC
Entity Type:Organization
Organization Name:DR. ANTHONY PENDOLINO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-436-1191
Mailing Address - Street 1:15715 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2694
Mailing Address - Country:US
Mailing Address - Phone:815-436-1191
Mailing Address - Fax:
Practice Address - Street 1:15715 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2694
Practice Address - Country:US
Practice Address - Phone:815-436-1191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350039985OtherRAILROAD MEDICARE
ILK22115Medicare PIN
IL350039985OtherRAILROAD MEDICARE