# BRICKTOWN MEDICAL GROUP PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568567238
- **Authorized official:** MARTIN RISS DO (PRESIDENT)
- **Authorized official phone:** (732) 458-0300

## Contact information

- **Practice address:** 34 LANES MILL RD, BRICK, NJ 08724
- **Practice address phone:** (732) 458-0300
- **Practice address fax:** (732) 458-8449
- **Mailing address:** 34 LANES MILL RD, BRICK, NJ 08724
- **Mailing address phone:** (732) 458-0300
- **Mailing address fax:** (732) 458-8449

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 02/23/2011