Provider Demographics
NPI:1477921971
Name:HOM, BRANDON J (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:J
Last Name:HOM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 ROUTE 9 N BLDG 1
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8307
Mailing Address - Country:US
Mailing Address - Phone:732-780-7650
Mailing Address - Fax:732-780-8817
Practice Address - Street 1:4247 ROUTE 9 N BLDG 1
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8307
Practice Address - Country:US
Practice Address - Phone:732-780-7650
Practice Address - Fax:732-780-8817
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00376300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant