Provider Demographics
NPI:1659328094
Name:BRUNEAU FAMILY CARE PC
Entity Type:Organization
Organization Name:BRUNEAU FAMILY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRZAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-638-1990
Mailing Address - Street 1:110 MARTER AVE
Mailing Address - Street 2:ST 408
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3124
Mailing Address - Country:US
Mailing Address - Phone:856-638-1990
Mailing Address - Fax:856-583-0359
Practice Address - Street 1:2963 MARNE HWY
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2036
Practice Address - Country:US
Practice Address - Phone:856-638-1990
Practice Address - Fax:856-583-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8712701Medicaid
NJH13542Medicare UPIN
NJ00075128Medicare ID - Type Unspecified