1821057902 NPI number — BAYSIDE PEDIATRICS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821057902 NPI number — BAYSIDE PEDIATRICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYSIDE PEDIATRICS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821057902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4728 N HABANA AVE
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33614-7100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-870-6501
Provider Business Mailing Address Fax Number:
813-870-6109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4728 N HABANA AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33614-7100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-870-6501
Provider Business Practice Location Address Fax Number:
813-870-6109
Provider Enumeration Date:
03/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PINZON
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
NAPOLEON
Authorized Official Title or Position:
VP MEDICAL DIRECTOR
Authorized Official Telephone Number:
813-870-6501

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)