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General NPI Number Information
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NPI Number | 1578862934
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Entity Type | Organization
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Legal Business Name | BRICK CITY HEALTH CENTER
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Dates
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Enumeration Date | 03/23/2011
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 195 CENTRAL AVE
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City | NEWARK
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State | NJ
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Zip | 07103-3921
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Country | US
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Telephone | 973-732-6060
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Fax | 973-732-6066
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Provider Business Mailing Address
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Address Line | 195 CENTRAL AVE
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City | NEWARK
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State | NJ
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Zip | 07103-3921
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Country | US
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Telephone | 973-732-6060
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Fax | 973-732-6066
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SURINDER SODHI
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Credential | MD
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Telephone | 973-732-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 25MA07075900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 25MA08785600
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 25MA05498100
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License Number State | NJ
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