Provider Demographics
NPI:1942908694
Name:REJUVEINATE OF ILLINOIS PLLC
Entity Type:Organization
Organization Name:REJUVEINATE OF ILLINOIS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-414-8201
Mailing Address - Street 1:28 HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1215
Mailing Address - Country:US
Mailing Address - Phone:443-414-8201
Mailing Address - Fax:
Practice Address - Street 1:4711 GOLF RD STE 100
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1239
Practice Address - Country:US
Practice Address - Phone:443-414-8201
Practice Address - Fax:973-860-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty