Provider Demographics
NPI:1700909447
Name:BAY DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:BAY DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
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
Authorized Official - Phone:732-557-9300
Mailing Address - Street 1:86 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7554
Mailing Address - Country:US
Mailing Address - Phone:732-557-9300
Mailing Address - Fax:732-557-9010
Practice Address - Street 1:86 E WATER ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7554
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:2007-04-09
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67229207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ038112Medicare PIN