Provider Demographics
NPI:1194155200
Name:MEDLINE HEALTH GROUP LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:MEDLINE HEALTH GROUP LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PLAMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-283-6896
Mailing Address - Street 1:984 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-2033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:984 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-2033
Practice Address - Country:US
Practice Address - Phone:646-283-6896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1005873416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport