1740221050 NPI number — DR. BRAD GURNEY D.O.

Table of content: DR. BRAD GURNEY D.O. (NPI 1740221050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740221050 NPI number — DR. BRAD GURNEY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GURNEY
Provider First Name:
BRAD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GURNEY
Provider Other First Name:
BRAD
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1740221050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 N GASTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08876-1714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-292-1430
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07201-2039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-289-5646
Provider Business Practice Location Address Fax Number:
908-351-1099
Provider Enumeration Date:
06/09/2006

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: 207Q00000X , with the licence number:  25MB066456 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: OS 8870 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MB 066456 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083X0100X , with the licence number: 25MB066456 , 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)