Provider Demographics
NPI:1245309111
Name:BAYSIDE LABORATORIES
Entity type:Organization
Organization Name:BAYSIDE LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PESTUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-229-8800
Mailing Address - Street 1:4557 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3354
Mailing Address - Country:US
Mailing Address - Phone:718-229-8800
Mailing Address - Fax:718-224-7225
Practice Address - Street 1:T. BAYSIDE LABORA LAB
Practice Address - Street 2:45 57 BELL BLVD
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3354
Practice Address - Country:US
Practice Address - Phone:718-229-8800
Practice Address - Fax:718-224-7225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D0149650291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0030953Medicaid
NY00996658Medicaid
NJ0030953Medicaid