MEDICARE: BRA & GIRDLE FACTORY OF BRICK INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1578639241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRA & GIRDLE FACTORY OF BRICK INC

Provider Business Mailing Address
First Line	:	1900 HIGHWAY 70
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-7324
Country	:	US
Telephone Number	:	732-477-2227
Fax Number	:	732-477-1732

Provider Business Practice Location Address
First Line	:	1900 HIGHWAY 70
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-7324
Country	:	US
Telephone Number	:	732-477-2227
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CHERYL TEITELBAUM
Credential	:	CMF
Telephone Number	:	732-477-2227

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	12/14/2012

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