Provider Demographics
NPI:1609937572
Name:ROONEY, JOHN EDWARD (CP, CPED, LO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:ROONEY
Suffix:
Gender:M
Credentials:CP, CPED, LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E ROOSEVELT RD
Mailing Address - Street 2:SUITE B & C
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4561
Mailing Address - Country:US
Mailing Address - Phone:630-261-9317
Mailing Address - Fax:630-261-9319
Practice Address - Street 1:121 E ROOSEVELT RD
Practice Address - Street 2:SUITE B & C
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4561
Practice Address - Country:US
Practice Address - Phone:630-261-9317
Practice Address - Fax:630-261-9319
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL335E00000X, 335E00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2271316OtherBC BS INSURANCE
IL4486340001Medicare UPIN
IL1609937572Medicare PIN