Provider Demographics
NPI:1053671024
Name:BAYSIDE ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:BAYSIDE ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:S
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:I
Authorized Official - Credentials:DO
Authorized Official - Phone:732-966-6317
Mailing Address - Street 1:780 ROUTE 37 W STE 330
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5059
Mailing Address - Country:US
Mailing Address - Phone:732-966-6317
Mailing Address - Fax:732-998-8086
Practice Address - Street 1:780 ROUTE 37 W STE 330
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5059
Practice Address - Country:US
Practice Address - Phone:732-966-6317
Practice Address - Fax:732-998-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB069402207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8050503Medicaid
NJG98526Medicare UPIN