Provider Demographics
NPI:1346539137
Name:BAYSIDE SPINE & REHAB CENTER LLC
Entity Type:Organization
Organization Name:BAYSIDE SPINE & REHAB CENTER LLC
Other - Org Name:HEALTHY SPINE & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SIELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-376-0141
Mailing Address - Street 1:333A STATE ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333A STATE ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4117
Practice Address - Country:US
Practice Address - Phone:732-376-0267
Practice Address - Fax:732-376-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00410600261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service