Provider Demographics
NPI:1396790705
Name:MLN REHAB., INC.
Entity type:Organization
Organization Name:MLN REHAB., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FREYLIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-962-2705
Mailing Address - Street 1:28 DALTON WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-5304
Mailing Address - Country:US
Mailing Address - Phone:215-968-5159
Mailing Address - Fax:215-968-5159
Practice Address - Street 1:12033 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2107
Practice Address - Country:US
Practice Address - Phone:215-671-8840
Practice Address - Fax:215-671-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058411L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty