1184067944 NPI number — DOCTORS OFFICE OF BRICK

Table of content: (NPI 1184067944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184067944 NPI number — DOCTORS OFFICE OF BRICK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS OFFICE OF BRICK
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:
1184067944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
484 TEMPLE HILL RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
NEW WINDSOR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12553-5557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-565-3700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
686 ROUTE 70
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08723-4026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-262-8200
Provider Business Practice Location Address Fax Number:
732-262-8203
Provider Enumeration Date:
04/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RUVO
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
GEN PARTNER
Authorized Official Telephone Number:
845-565-3700

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0410411 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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