Provider Demographics
NPI:1407507601
Name:MLB THERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:MLB THERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT MA
Authorized Official - Phone:551-265-2651
Mailing Address - Street 1:37 DAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3331
Mailing Address - Country:US
Mailing Address - Phone:551-265-2651
Mailing Address - Fax:
Practice Address - Street 1:37 DAKOTA ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3331
Practice Address - Country:US
Practice Address - Phone:551-265-2651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health