Provider Demographics
NPI:1093731473
Name:BENEFICIAL MEDICAL SUPPLY
Entity Type:Organization
Organization Name:BENEFICIAL MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKSHIYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-773-4566
Mailing Address - Street 1:361 PASSAIC STR
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5818
Mailing Address - Country:US
Mailing Address - Phone:973-773-4566
Mailing Address - Fax:973-473-8868
Practice Address - Street 1:361 PASSAIC STR
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5818
Practice Address - Country:US
Practice Address - Phone:973-773-4566
Practice Address - Fax:973-473-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0382868Medicaid
NJ0382868Medicaid