Provider Demographics
NPI:1508892829
Name:BRUNER, LAURIE R (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:R
Last Name:BRUNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:A
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 HURFFVILLE CROSSKEYS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9344
Mailing Address - Country:US
Mailing Address - Phone:856-582-0033
Mailing Address - Fax:856-582-2305
Practice Address - Street 1:405 HURFFVILLE CROSSKEYS RD STE 203
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9344
Practice Address - Country:US
Practice Address - Phone:856-582-0033
Practice Address - Fax:856-582-2305
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07235100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3Medicare PIN