Provider Demographics
NPI:1932117827
Name:BAYVIEW ENDOSCOPY CENTER INC
Entity Type:Organization
Organization Name:BAYVIEW ENDOSCOPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:DECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-644-0455
Mailing Address - Street 1:33663 BAYVIEW MEDICAL DR
Mailing Address - Street 2:UNIT 3
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1663
Mailing Address - Country:US
Mailing Address - Phone:302-644-0455
Mailing Address - Fax:302-645-5214
Practice Address - Street 1:33663 BAYVIEW MEDICAL DR
Practice Address - Street 2:UNIT 3
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1663
Practice Address - Country:US
Practice Address - Phone:302-644-0455
Practice Address - Fax:302-645-5214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1996103518261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000841528Medicaid
DE0000841528Medicaid