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Provider Information for 1689947848



COREY RUSSELL BRICK D.D.S.

Gender: MALE

Individual NPI: 1689947848

Calendar Last Updated: 2013-10-02

Details

Name Value
NPI 1689947848
Enumeration Date 2012-02-20
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 245 E. 63RD ST. SUITE #110
NEW YORK, NY 10065
United States

Phone: 212-838-6226 | Fax:
View Map External Link
Primary Practice Address 245 E. 63RD ST. SUITE #110
NEW YORK, NY 10065
United States

Phone: 212-838-6226 | Fax:
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist NY 056826
Other Identifiers
Issuer State Number