Organization
LIGHT SURGICAL SUPPLY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAFAEL MAKSUMOV (PRESIDENT)
(646) 930-7459
Entity
Organization
Contact information
Practice address
11610 QUEENS BLVD STE 101, FOREST HILLS, NY 11375-7055
(646) 930-7459
(646) 930-7462
Mailing address
11610 QUEENS BLVD STE 101, FOREST HILLS, NY 11375-7055
(646) 930-7459
(646) 930-7462
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NY
Other
Enumeration date
07/21/2009
Last updated
07/21/2022
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