Provider Demographics
NPI:1598234064
Name:ERIN BRUNTON, LLC
Entity Type:Organization
Organization Name:ERIN BRUNTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:BRIDGET
Authorized Official - Last Name:BRUNTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:917-757-9781
Mailing Address - Street 1:23 CLOVE WAY
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3634
Mailing Address - Country:US
Mailing Address - Phone:917-757-9781
Mailing Address - Fax:
Practice Address - Street 1:23 CLOVE WAY
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3634
Practice Address - Country:US
Practice Address - Phone:917-757-9781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1689935538OtherDOH