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General NPI Number Information
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NPI Number | 1053671024
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Entity Type | Organization
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Legal Business Name | BAYSIDE ORTHOPEDICS, LLC
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 780 ROUTE 37 W STE 330
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City | TOMS RIVER
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State | NJ
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Zip | 08755-5059
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Country | US
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Telephone | 732-966-6317
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Fax | 732-998-8086
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Provider Business Mailing Address
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Address Line | 780 ROUTE 37 W STE 330
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City | TOMS RIVER
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State | NJ
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Zip | 08755-5059
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Country | US
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Telephone | 732-966-6317
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Fax | 732-998-8086
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Authorized Official
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Title or Position | DR.
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Name | ERIK S LARSEN I
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Credential | D.O.
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Telephone | 732-966-6317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 25MB069402
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License Number State | NJ
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