Provider Demographics
NPI:1891172532
Name:HEALTHENGINE, LLC
Entity Type:Organization
Organization Name:HEALTHENGINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-300-8644
Mailing Address - Street 1:116 W HUBBARD ST
Mailing Address - Street 2:#7S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8542
Mailing Address - Country:US
Mailing Address - Phone:877-300-8644
Mailing Address - Fax:
Practice Address - Street 1:116 W HUBBARD ST
Practice Address - Street 2:#7S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-8542
Practice Address - Country:US
Practice Address - Phone:877-300-8644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization