Provider Demographics
NPI:1407967706
Name:BAYSIDE SURGICAL CENTER, INC.
Entity Type:Organization
Organization Name:BAYSIDE SURGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-761-4190
Mailing Address - Street 1:8023 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-7107
Mailing Address - Country:US
Mailing Address - Phone:410-761-4190
Mailing Address - Fax:410-761-0265
Practice Address - Street 1:8023 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-7107
Practice Address - Country:US
Practice Address - Phone:410-761-4190
Practice Address - Fax:410-761-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1167261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD02APOtherCAREFIRST BS PROV NUMBER
MDMT8OtherBS FEDERAL PROV NUMBER
MD02APOtherCAREFIRST BS PROV NUMBER
MD21C0001167Medicare Oscar/Certification
MD013ZMedicare PIN