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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
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist NY 056826