Provider Demographics
NPI:1285775726
Name:BAYSHORE PEDIATRICS,L.L.C.
Entity type:Organization
Organization Name:BAYSHORE PEDIATRICS,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAMZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-736-0110
Mailing Address - Street 1:558 COMMONS WAY
Mailing Address - Street 2:BUILDING E
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6432
Mailing Address - Country:US
Mailing Address - Phone:732-736-0110
Mailing Address - Fax:732-736-0990
Practice Address - Street 1:558 COMMONS WAY
Practice Address - Street 2:BUILDING E
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6432
Practice Address - Country:US
Practice Address - Phone:732-736-0110
Practice Address - Fax:732-736-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71443174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty