| NPI | 1679008676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELLY BAKSHIYEV Owner/President 732-580-0660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 225000000X Orthotic Fitter |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2017-04-27 |