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General NPI Number Information
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NPI Number | 1992818777
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Entity Type | Organization
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Legal Business Name | BRICK PSYCHIATRIC SERVICES INC
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 2640 HIGHWAY 70 STE 12-201
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City | MANASQUAN
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State | NJ
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Zip | 08736-2612
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Country | US
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Telephone | 732-202-0622
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Fax | 732-202-0620
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Provider Business Mailing Address
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Address Line | 2640 HIGHWAY 70 STE 12-201
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City | MANASQUAN
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State | NJ
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Zip | 08736-2612
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Country | US
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Telephone | 732-202-0622
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Fax | 732-202-0620
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SABIRA RAJPUT
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Credential | MD
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Telephone | 732-202-0622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA06739300
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License Number State | NJ
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