Provider Demographics
NPI:1518019579
Name:ROSLINDALE REHAB INC.
Entity type:Organization
Organization Name:ROSLINDALE REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INGA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:617-327-5600
Mailing Address - Street 1:4157 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1718
Mailing Address - Country:US
Mailing Address - Phone:617-327-5600
Mailing Address - Fax:617-327-5444
Practice Address - Street 1:4157 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131
Practice Address - Country:US
Practice Address - Phone:617-327-5600
Practice Address - Fax:617-327-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11357174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY61469OtherBLUE CROSS BLUE SHIELD