Provider Demographics
NPI:1093470304
Name:BRUNE, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BRUNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HILLSIDE BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3394
Mailing Address - Country:US
Mailing Address - Phone:732-380-5222
Mailing Address - Fax:
Practice Address - Street 1:110 HILLSIDE BLVD STE 7
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3394
Practice Address - Country:US
Practice Address - Phone:732-380-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst