Provider Demographics
NPI:1184067944
Name:DOCTORS OFFICE OF BRICK
Entity type:Organization
Organization Name:DOCTORS OFFICE OF BRICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GEN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-565-3700
Mailing Address - Street 1:484 TEMPLE HILL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5557
Mailing Address - Country:US
Mailing Address - Phone:845-565-3700
Mailing Address - Fax:
Practice Address - Street 1:686 ROUTE 70
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4026
Practice Address - Country:US
Practice Address - Phone:732-262-8200
Practice Address - Fax:732-262-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0410411Medicaid
NJ308252Medicare PIN