=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982521126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUMEN DENTAL WOODBRIDGE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2026
-----------------------------------------------------
Last Update Date | 06/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 RAHWAY AVE
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07095-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-636-8002
-----------------------------------------------------
Fax | 732-726-0817
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 502 RAHWAY AVE
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07095-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-636-8002
-----------------------------------------------------
Fax | 732-726-0817
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. VLAD BARSKIY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-404-6866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------