Provider Demographics
NPI:1053317636
Name:BRENER, BRUCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:BRENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5817
Mailing Address - Country:US
Mailing Address - Phone:973-322-7233
Mailing Address - Fax:973-322-7499
Practice Address - Street 1:200 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:973-322-7233
Practice Address - Fax:973-322-7499
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02742400208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1812408Medicaid
NJ1812408Medicaid
NJD96530Medicare UPIN