Provider Demographics
NPI:1578639241
Name:BRA & GIRDLE FACTORY OF BRICK INC
Entity Type:Organization
Organization Name:BRA & GIRDLE FACTORY OF BRICK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEITELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:732-477-2227
Mailing Address - Street 1:1900 HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-7324
Mailing Address - Country:US
Mailing Address - Phone:732-477-2227
Mailing Address - Fax:732-477-1732
Practice Address - Street 1:1900 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-7324
Practice Address - Country:US
Practice Address - Phone:732-477-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4308050001Medicare NSC