Organization
ICONIC WELLNESS SURGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SADYK FAYZULAYEV PA (MANAGING MEMBER)
(201) 444-1645
Entity
Organization
Contact information
Practice address
139 HARRISTOWN RD, STE 205, GLEN ROCK, NJ 07452-3312
(201) 444-1645
(201) 444-1787
Mailing address
139 HARRISTOWN RD, STE 205, GLEN ROCK, NJ 07452-3312
(201) 444-1645
(201) 444-1787
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
25MP00262900
NJ
Other
Enumeration date
01/11/2016
Last updated
01/11/2016
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