Provider Demographics
NPI:1851983696
Name:EPSTEIN, ABIYAHDOV MATTISYAHU (LMT, CLDT)
Entity Type:Individual
Prefix:
First Name:ABIYAHDOV
Middle Name:MATTISYAHU
Last Name:EPSTEIN
Suffix:
Gender:M
Credentials:LMT, CLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3644
Mailing Address - Country:US
Mailing Address - Phone:312-824-1427
Mailing Address - Fax:
Practice Address - Street 1:5940 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3644
Practice Address - Country:US
Practice Address - Phone:312-824-1427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.020375225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty