Provider Demographics
NPI:1396017000
Name:BRICK WOMEN'S PHYSICIANS
Entity Type:Organization
Organization Name:BRICK WOMEN'S PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-202-0700
Mailing Address - Street 1:87 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3633
Mailing Address - Country:US
Mailing Address - Phone:732-202-0700
Mailing Address - Fax:732-202-0664
Practice Address - Street 1:87 UNION AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3633
Practice Address - Country:US
Practice Address - Phone:732-202-0700
Practice Address - Fax:732-202-0664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRICK WOMEN'S PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-27
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8646708Medicaid
NJ049963Medicare PIN