Healthcare Provider Details

I. General information

NPI: 1679702476
Provider Name (Legal Business Name): BAY DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 ROUTE 37 W STE 235
TOMS RIVER NJ
08755-5065
US

IV. Provider business mailing address

780 ROUTE 37 W STE 235
TOMS RIVER NJ
08755-5065
US

V. Phone/Fax

Practice location:
  • Phone: 732-557-9300
  • Fax: 732-557-9010
Mailing address:
  • Phone: 732-557-9300
  • Fax: 732-557-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SAL THOMAS LAFORGIA
Title or Position: SHAREHOLDER
Credential: MD, PHD
Phone: 732-557-9300