Provider Demographics
NPI:1801046164
Name:BAYSIDE SPINE AND REHAB CENTER LLC
Entity Type:Organization
Organization Name:BAYSIDE SPINE AND REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
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:848-203-3299
Mailing Address - Street 1:202 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4106
Mailing Address - Country:US
Mailing Address - Phone:848-203-3299
Mailing Address - Fax:
Practice Address - Street 1:202 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4106
Practice Address - Country:US
Practice Address - Phone:848-203-3299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty