Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | IL | |
Y | 222Z00000X | Podiatrist | IL |
NPI | 1033169693 |
---|---|
Provider Name | Jay Andrew Hengel |
First Address | Westchester, IL 60154-5201 |
Second Address | Westchester, IL 60154-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 07/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01623487 | BC/BS OF IL (01) | IL |
U79164 | (02) | IL |