Provider Demographics
NPI:1104917343
Name:BRICKMAN, ALAN MARK (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MARK
Last Name:BRICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 52ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3802
Mailing Address - Country:US
Mailing Address - Phone:718-436-9898
Mailing Address - Fax:718-854-1123
Practice Address - Street 1:1318 52ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3802
Practice Address - Country:US
Practice Address - Phone:718-436-9898
Practice Address - Fax:718-854-1123
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00133229207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00133229OtherNYS LICENSE#
NY00641525Medicaid
NYP671498OtherOXFORD INSURANCE#
11-2572056OtherTAX ID#
NY00133229OtherNYS LICENSE#
11-2572056OtherTAX ID#