Provider Demographics
NPI:1073624904
Name:BRUMER, YELENA (P T)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:BRUMER
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 SAINT ANDREWS PL
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-9542
Mailing Address - Country:US
Mailing Address - Phone:732-792-6101
Mailing Address - Fax:
Practice Address - Street 1:548 SAINT ANDREWS PL
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-9542
Practice Address - Country:US
Practice Address - Phone:732-792-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025896225100000X
NJ40QA01231100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025896OtherPHYSICAL THERAPIST