Provider Demographics
NPI:1720109952
Name:BAYSHORE PEDIATRIC ASSOCIATION LLC
Entity type:Organization
Organization Name:BAYSHORE PEDIATRIC ASSOCIATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DUCK
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-888-0010
Mailing Address - Street 1:717 N BEERS ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1524
Mailing Address - Country:US
Mailing Address - Phone:732-888-0010
Mailing Address - Fax:732-888-0012
Practice Address - Street 1:717 N BEERS ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1524
Practice Address - Country:US
Practice Address - Phone:732-888-0010
Practice Address - Fax:732-888-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty