Provider Demographics
NPI:1992713655
Name:BAYSIDE MEDICAL AND REHABILITATION CENTER PC
Entity type:Organization
Organization Name:BAYSIDE MEDICAL AND REHABILITATION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DASIKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-823-0303
Mailing Address - Street 1:1160 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3128
Mailing Address - Country:US
Mailing Address - Phone:201-823-0303
Mailing Address - Fax:201-436-6180
Practice Address - Street 1:1160 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3128
Practice Address - Country:US
Practice Address - Phone:201-823-0303
Practice Address - Fax:201-436-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00232600111N00000X
NJ38MC00234100111N00000X
NJ25MA03289800204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty