Provider Demographics
NPI:1699704346
Name:AVERBUCH INSTITUTE OF VERTEBRONEUROLOGY
Entity type:Organization
Organization Name:AVERBUCH INSTITUTE OF VERTEBRONEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERBUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-755-3278
Mailing Address - Street 1:1575 BARRINGTON RD STE 520
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60194-1066
Mailing Address - Country:US
Mailing Address - Phone:847-755-3278
Mailing Address - Fax:847-490-6912
Practice Address - Street 1:1575 BARRINGTON RD STE 520
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1066
Practice Address - Country:US
Practice Address - Phone:847-755-3278
Practice Address - Fax:847-490-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634452OtherBLUE SHIELD PROVIDER NUMB
IL209453Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER