Provider Demographics
NPI:1225505654
Name:BRUNSWICK AUTOMOTIVE PROFESSIONALS INC.
Entity Type:Organization
Organization Name:BRUNSWICK AUTOMOTIVE PROFESSIONALS INC.
Other - Org Name:BRUNSWICK MOBILITY PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:AVELLINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-545-6300
Mailing Address - Street 1:1490 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-2011
Mailing Address - Country:US
Mailing Address - Phone:732-545-6300
Mailing Address - Fax:732-514-0304
Practice Address - Street 1:1490 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-2011
Practice Address - Country:US
Practice Address - Phone:732-545-6300
Practice Address - Fax:732-514-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies