Provider Demographics
NPI:1073924866
Name:B&G REHAB INC.
Entity Type:Organization
Organization Name:B&G REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:B.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GORALNIK
Authorized Official - Suffix:
Authorized Official - Credentials:ORTHOTIST
Authorized Official - Phone:386-310-4359
Mailing Address - Street 1:533 N NOVA RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4447
Mailing Address - Country:US
Mailing Address - Phone:386-310-4359
Mailing Address - Fax:386-310-4394
Practice Address - Street 1:533 N NOVA RD
Practice Address - Street 2:SUITE 109
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4447
Practice Address - Country:US
Practice Address - Phone:386-310-4359
Practice Address - Fax:386-310-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier