| Bricktown Medical Group Pa | |
|
34 Lanes Mill Rd Brick NJ 08724 | |
| (732) 458-0300 | |
| (732) 458-8449 |
| Full Name | Bricktown Medical Group Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 34 Lanes Mill Rd, Brick, New Jersey |
| Authorized Official Name and Position | Martin Riss (PRESIDENT) |
| Authorized Official Contact | 7324580300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bricktown Medical Group Pa 34 Lanes Mill Rd Brick NJ 08724 Ph: (732) 458-0300 | Bricktown Medical Group Pa 34 Lanes Mill Rd Brick NJ 08724 Ph: (732) 458-0300 |
| NPI Number | 1568567238 |
|---|---|
| Provider Enumeration Date | 09/14/2006 |
| Last Update Date | 02/23/2011 |
| Medicare PECOS PAC ID | 8729276217 |
|---|---|
| Medicare Enrollment ID | O20101228000604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568567238 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Martin Riss |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548276827 PECOS PAC ID: 0840488714 Enrollment ID: I20101218000011 |
| Provider Name | Lily Babayev |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851307136 PECOS PAC ID: 3476741968 Enrollment ID: I20101228000586 |
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