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General NPI Number Information
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NPI Number | 1326301185
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Entity Type | Organization
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Legal Business Name | ON-SITE MEDICAL GROUP PC
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 03/01/2019
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Provider Practice Location Address
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Address Line | 50 US HIGHWAY 9 NORTH, SUITE 102 GROSSO OFFICE PARK
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City | MORGANVILLE
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State | NJ
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Zip | 07751-1558
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Country | US
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Telephone | 732-580-0660
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Fax |
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Provider Business Mailing Address
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Address Line | 50 US HIGHWAY 9 NORTH, SUITE 108 GROSSO OFFICE PARK
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City | MORGANVILLE
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State | NJ
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Zip | 07751-1558
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING
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Name | SVETLANA BAKSHIYEVA
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Credential |
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Telephone | 732-580-0660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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