MEDICARE: MTL OPCO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1588441851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MTL OPCO LLC

Provider Business Mailing Address
First Line	:	395 PEARSALL AVE STE K
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-1828
Country	:	US
Telephone Number	:	718-216-9468
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 OLD GILKESON RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1063
Country	:	US
Telephone Number	:	516-447-5923
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED MEMBER
Name	:	GEDALIAH WIELGUS
Credential	:
Telephone Number	:	516-447-5923

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	09/11/2023

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Directions to “MTL OPCO LLC ” Practice Location

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