1124089529 NPI number — MBL ASSOCIATES INC.

Table of content: (NPI 1124089529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124089529 NPI number — MBL ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MBL ASSOCIATES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124089529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 258
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYDS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20841-0258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-370-1095
Provider Business Mailing Address Fax Number:
301-340-6403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 S ADAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-4239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-370-1095
Provider Business Practice Location Address Fax Number:
301-340-6403
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LITELL
Authorized Official First Name:
MUNJANJA
Authorized Official Middle Name:
YVONNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-370-1095

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  0305001 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , with the licence number: R2210 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 251865 . This is a "KAISER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7730692 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1052247 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1021073 . This is a "UNITED HEALTH CARE (ACM)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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