Provider Demographics
NPI:1821274937
Name:WEST SUBURBAN PEDIATRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:WEST SUBURBAN PEDIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARUBINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-343-1300
Mailing Address - Street 1:947 S MANNHEIM RD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:947 S MANNHEIM RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2515
Practice Address - Country:US
Practice Address - Phone:708-343-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623531OtherBCBS
IL355491Medicare PIN
ILF93030Medicare UPIN