Provider Demographics
NPI:1780718056
Name:BAYSIDE OB/GYN, INC.
Entity type:Organization
Organization Name:BAYSIDE OB/GYN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:IACOBBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-421-1710
Mailing Address - Street 1:235 PLAIN ST
Mailing Address - Street 2:201
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 PLAIN ST
Practice Address - Street 2:201
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3240
Practice Address - Country:US
Practice Address - Phone:401-421-1710
Practice Address - Fax:401-861-2164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD6286261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
C90159Medicare UPIN
D87373Medicare UPIN
H24043Medicare UPIN
I62229Medicare UPIN
I25235Medicare UPIN
G16775Medicare UPIN
F19402Medicare UPIN