Provider Demographics
NPI:1679702476
Name:BAY DERMATOLOGY PC
Entity Type:Organization
Organization Name:BAY DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LAFORGIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:732-557-9300
Mailing Address - Street 1:780 ROUTE 37 W STE 235
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5065
Mailing Address - Country:US
Mailing Address - Phone:732-557-9300
Mailing Address - Fax:732-557-9010
Practice Address - Street 1:780 ROUTE 37 W STE 235
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5065
Practice Address - Country:US
Practice Address - Phone:732-557-9300
Practice Address - Fax:732-557-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty