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General NPI Number Information
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NPI Number | 1982834461
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Entity Type | Organization
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Legal Business Name | MINIMALLY INVASIVE SURGICAL ASSOC. OF NJ LLC
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 07/20/2009
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Provider Practice Location Address
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Address Line | 3100 QUAKERBRIDGE RD
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City | HAMILTON
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State | NJ
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Zip | 08619-1658
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Country | US
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Telephone | 347-426-6146
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Fax |
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Provider Business Mailing Address
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Address Line | 176 SHINNECOCK DR
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City | MANALAPAN
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State | NJ
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Zip | 07726-9511
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Country | US
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Telephone | 347-426-6146
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. YELIZAVETA DOBRUSKIN
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Credential | M.D.
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Telephone | 347-426-6146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA08100700
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License Number State | NJ
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