Provider Demographics
NPI:1326224197
Name:RICHARD J BRAY
Entity Type:Organization
Organization Name:RICHARD J BRAY
Other - Org Name:BRAY ORTHOTICS AND PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFIICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-666-6647
Mailing Address - Street 1:217 OLD HOOK RD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3130
Mailing Address - Country:US
Mailing Address - Phone:201-666-6647
Mailing Address - Fax:201-666-5551
Practice Address - Street 1:217 OLD HOOK RD
Practice Address - Street 2:SUITE 3B
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3130
Practice Address - Country:US
Practice Address - Phone:201-666-6647
Practice Address - Fax:201-666-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00014900335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1043660001Medicare NSC