Provider Demographics
NPI:1528223211
Name:MBF REHAB PHYSICAL & OCCUPATIONAL THERAPY PLLC
Entity Type:Organization
Organization Name:MBF REHAB PHYSICAL & OCCUPATIONAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARANOV
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-380-4597
Mailing Address - Street 1:156-11 AGULIAR AVE
Mailing Address - Street 2:P3
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:718-380-4597
Mailing Address - Fax:718-382-5252
Practice Address - Street 1:550 REMSEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-1002
Practice Address - Country:US
Practice Address - Phone:718-380-4597
Practice Address - Fax:718-382-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0212692081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02122365Medicaid
NY02405549Medicaid
NY02122365Medicaid
NYA100001786Medicare PIN
NYX95648Medicare UPIN
NYA400020360Medicare PIN