Organization
OPTIMAL CARE SURGICAL SERVICES
Active
Organization
OPTIMAL CARE SURGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BORIS KHAIMOV PA (MANAGING MEMBER)
(718) 431-5251
Entity
Organization
Contact information
Practice address
139 HARRISTOWN RD, 205, GLEN ROCK, NJ 07452-3312
(718) 431-5251
Mailing address
139 HARRISTOWN RD, 205, GLEN ROCK, NJ 07452-3312
(718) 431-5251
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
25MP00236800
NJ
Other
Enumeration date
04/22/2016
Last updated
04/22/2016
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