Provider Demographics
NPI:1558576843
Name:NORTHEAST ENDOCRINOLOGY
Entity Type:Organization
Organization Name:NORTHEAST ENDOCRINOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:NADKARNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-741-9714
Mailing Address - Street 1:2222 WEBER RD.
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2222 WEBER RD
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60435-0928
Practice Address - Country:US
Practice Address - Phone:815-741-9714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0306097480Medicaid
IL0306097480Medicaid
ILG74763Medicare UPIN