1528079829 NPI number — DR. BRUCE J BRUMBERGER MD

Table of content: DR. BRUCE J BRUMBERGER MD (NPI 1528079829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528079829 NPI number — DR. BRUCE J BRUMBERGER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUMBERGER
Provider First Name:
BRUCE
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1528079829
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:
4 FARM SPRINGS RD
Provider Second Line Business Mailing Address:
PROHEALTH PHYSICIANS
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06032-2573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-284-5200
Provider Business Mailing Address Fax Number:
860-284-5333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
816 BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 24
Provider Business Practice Location Address City Name:
MERIDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06450-4350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-634-0086
Provider Business Practice Location Address Fax Number:
203-237-6010
Provider Enumeration Date:
08/11/2006

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:  017829 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com