Provider Demographics
NPI:1336386754
Name:MLS MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:MLS MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-819-8049
Mailing Address - Street 1:293 PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5803
Mailing Address - Country:US
Mailing Address - Phone:201-783-0780
Mailing Address - Fax:201-664-0853
Practice Address - Street 1:293 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5803
Practice Address - Country:US
Practice Address - Phone:201-783-0780
Practice Address - Fax:201-664-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center