Provider Demographics
NPI:1568181998
Name:ADVANCED NEUROPSYCHIATRIC SERVICES OF NORTHWEST INDIANA
Entity Type:Organization
Organization Name:ADVANCED NEUROPSYCHIATRIC SERVICES OF NORTHWEST INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:FANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-728-6247
Mailing Address - Street 1:493 S PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3935
Mailing Address - Country:US
Mailing Address - Phone:630-728-6247
Mailing Address - Fax:
Practice Address - Street 1:1904 HART ST APT D
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2661
Practice Address - Country:US
Practice Address - Phone:630-728-6247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty