Provider Demographics
NPI:1114181963
Name:BRYLKA, DOUGLAS ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:BRYLKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 SPRINGFIELD AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1041
Mailing Address - Country:US
Mailing Address - Phone:212-746-6000
Mailing Address - Fax:
Practice Address - Street 1:525 EAST 68TH STREET
Practice Address - Street 2:BOX 141
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4885
Practice Address - Country:US
Practice Address - Phone:212-746-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09996500261QR0200X
NY2568392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty