Organization
MAIN SURGICAL CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NELLY BAKSHIYEV (MANAGER/OWNER)
(973) 482-8787
Entity
Organization
Contact information
Practice address
84 BROADWAY, NEWARK, NJ 07104
(973) 482-8787
(973) 484-4004
Mailing address
PO BOX 1620, LIVINGSTON, NJ 07039-7220
(973) 482-8787
(973) 484-4004
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
NJ
224P00000X
Prosthetist
—
NJ
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0385468
—
NJ
Enumeration date
08/04/2006
Last updated
05/27/2014
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