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General NPI Number Information
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NPI Number | 1972742732
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Entity Type | Organization
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Legal Business Name | MAG GROUP PC
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 25 KNOLL RD
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City | WAYNE
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State | NJ
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Zip | 07470-6125
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Country | US
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Telephone | 862-226-9549
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Fax |
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Provider Business Mailing Address
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Address Line | 25 KNOLL RD
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City | WAYNE
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State | NJ
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Zip | 07470-6125
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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 | OWNER
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Name | DR. ALEXANDER ZAITSEV
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Credential | MD
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Telephone | 973-907-2358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA07388400
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License Number State | NJ
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