Provider Demographics
NPI:1578862934
Name:BRICK CITY HEALTH CENTER
Entity Type:Organization
Organization Name:BRICK CITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SODHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-732-6060
Mailing Address - Street 1:195 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-3921
Mailing Address - Country:US
Mailing Address - Phone:973-732-6060
Mailing Address - Fax:973-732-6066
Practice Address - Street 1:195 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3921
Practice Address - Country:US
Practice Address - Phone:973-732-6060
Practice Address - Fax:973-732-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05498100261Q00000X
NJ25MA07075900261Q00000X
NJ25MA08785600261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center