Healthcare Provider Details

I. General information

NPI: 1831248509
Provider Name (Legal Business Name): DELAWARE BAY SURGICAL SERVICE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33664 BAYVIEW MEDICAL DRIVE UNIT 2
LEWES DE
19958
US

IV. Provider business mailing address

33664 BAYVIEW MEDICAL DRIVE UNIT 2
LEWES DE
19958
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-4954
  • Fax: 302-645-5481
Mailing address:
  • Phone: 302-644-4954
  • Fax: 302-645-5481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000358
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberC2-0007933
License Number StateDE

VIII. Authorized Official

Name: MAYER M KATZ
Title or Position: OWNER
Credential: M.D.
Phone: 302-645-5650