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General NPI Number Information
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NPI Number | 1558379412
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Entity Type | Organization
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Legal Business Name | MAIN SURGICAL CO
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 05/27/2014
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Provider Practice Location Address
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Address Line | 84 BROADWAY
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City | NEWARK
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State | NJ
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Zip | 07104
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Country | US
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Telephone | 973-482-8787
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Fax | 973-484-4004
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Provider Business Mailing Address
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Address Line | PO BOX 1620
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City | LIVINGSTON
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State | NJ
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Zip | 07039-7220
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Country | US
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Telephone | 973-482-8787
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Fax | 973-484-4004
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | NELLY BAKSHIYEV
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Credential |
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Telephone | 973-482-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | NJ
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