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Individual

DR. RAISA BAKSHIYEV

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
425 JACK MARTIN BLVD, BRICK, NJ 08724-7732
(732) 836-4504
(732) 836-4532
Mailing address
65 JAMES ST, EDISON, NJ 08820-3947
(732) 321-7070
(732) 321-7330

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
25MA09836100
NJ
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
290336
NY

Other

Enumeration date
05/01/2013
Last updated
07/02/2019
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