Provider Demographics
NPI:1891136982
Name:IJAM SERVICES INC
Entity type:Organization
Organization Name:IJAM SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED SURGICAL ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANIKATOV
Authorized Official - Suffix:
Authorized Official - Credentials:RSA
Authorized Official - Phone:630-357-2464
Mailing Address - Street 1:520 PEACOCK CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-4164
Mailing Address - Country:US
Mailing Address - Phone:630-544-8473
Mailing Address - Fax:
Practice Address - Street 1:520 PEACOCK CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-4164
Practice Address - Country:US
Practice Address - Phone:630-544-8473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty