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General NPI Number Information
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NPI Number | 1013018365
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Entity Type | Organization
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Legal Business Name | BAYSHORE WOUND CARE CENTER
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 BETHANY RD BUILDING 3, SUITE 41
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City | HAZLET
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State | NJ
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Zip | 07730-1663
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Country | US
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Telephone | 732-203-9780
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Fax | 732-203-9781
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Provider Business Mailing Address
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Address Line | 24 N LAKE DR
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-2347
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Country | US
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Telephone | 732-977-4211
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Fax |
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Authorized Official
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Title or Position | NP
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Name | MS. ROSE WEISSMAN
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Credential | FNP
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Telephone | 732-977-4211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 26NJ00040900
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License Number State | NJ
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