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General NPI Number Information
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NPI Number | 1548213440
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Entity Type | Organization
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Legal Business Name | BAYSHORE MEDICAL GROUP PC
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 146 RTE 9 MARLBORO PLAZA
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City | ENGLISHTOWN
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State | NJ
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Zip | 07726-8249
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Country | US
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Telephone | 732-972-0660
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Fax |
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Provider Business Mailing Address
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Address Line | 156 RTE 9 MARLBORO PLAZA
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City | ENGLISHTOWN
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State | NJ
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Zip | 07726-8231
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Country | US
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Telephone | 732-972-0660
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. L SCOTT LARSEN
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Credential | M.D.
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Telephone | 732-888-7353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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