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Organization

BAYSHORE PAIN MANAGEMENT LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CHARLES DIETRICH (ADMINISTRATOR)
(732) 264-8900
Entity
Organization

Contact information

Practice address
250 MAPLE PL, KEYPORT, NJ 07735-1144
(732) 264-8900
Mailing address
250 MAPLE PL, KEYPORT, NJ 07735-1144
(732) 264-8900

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Enumeration date
11/03/2014
Last updated
11/03/2014
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