Provider Demographics
NPI:1689935538
Name:BRUNTON, ERIN BRIDGET (MSED)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:BRIDGET
Last Name:BRUNTON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:BRIDGET
Other - Last Name:KENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1523 74TH ST
Mailing Address - Street 2:APT # 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2209
Mailing Address - Country:US
Mailing Address - Phone:917-757-9781
Mailing Address - Fax:
Practice Address - Street 1:7616 13TH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228
Practice Address - Country:US
Practice Address - Phone:718-630-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist