Healthcare Provider Details

I. General information

NPI: 1891859484
Provider Name (Legal Business Name): BRICK RHEUMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 ROUTE 88 SUITE 203
BRICK NJ
08724-3036
US

IV. Provider business mailing address

1640 ROUTE 88 SUITE 203
BRICK NJ
08724-3036
US

V. Phone/Fax

Practice location:
  • Phone: 732-458-7777
  • Fax: 732-458-6741
Mailing address:
  • Phone: 732-458-7777
  • Fax: 732-458-6741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: CARRIE A EDELMAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 732-458-7777