Provider Demographics
NPI:1942594759
Name:BAYSIDE HOUSE CALL GROUP LLC
Entity Type:Organization
Organization Name:BAYSIDE HOUSE CALL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:800-513-3680
Mailing Address - Street 1:2 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-3102
Mailing Address - Country:US
Mailing Address - Phone:800-513-3680
Mailing Address - Fax:888-503-8365
Practice Address - Street 1:2 E 14TH ST
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-3102
Practice Address - Country:US
Practice Address - Phone:800-513-3680
Practice Address - Fax:888-503-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03241600207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty