1043254956 NPI number — DR. THOMAS W BRUNO DC

Table of content: DR. THOMAS W BRUNO DC (NPI 1043254956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043254956 NPI number — DR. THOMAS W BRUNO DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNO
Provider First Name:
THOMAS
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043254956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
158 MAIN ST
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
MATAWAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-583-7722
Provider Business Mailing Address Fax Number:
732-583-9197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
158 MAIN ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
MATAWAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-583-7722
Provider Business Practice Location Address Fax Number:
732-583-9197
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  MC02407 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 156792 . This is a "ONE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 538053 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 050002507NJ01 . This is a "ANTHEM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0094582 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0730004000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 378136 . This is a "UNITED HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: X47221 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1089803 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P413276 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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