Healthcare Provider Details

I. General information

NPI: 1992713655
Provider Name (Legal Business Name): BAYSIDE MEDICAL AND REHABILITATION CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 KENNEDY BLVD
BAYONNE NJ
07002-3128
US

IV. Provider business mailing address

1160 KENNEDY BLVD
BAYONNE NJ
07002-3128
US

V. Phone/Fax

Practice location:
  • Phone: 201-823-0303
  • Fax: 201-436-6180
Mailing address:
  • Phone: 201-823-0303
  • Fax: 201-436-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00232600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number25MA03289800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00234100
License Number StateNJ

VIII. Authorized Official

Name: DR. VIJAYA R DASIKA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-823-0303