Provider Demographics
NPI:1710364112
Name:BRUIN NEUROPHYSIOLOGY, P.C.
Entity Type:Organization
Organization Name:BRUIN NEUROPHYSIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-351-8417
Mailing Address - Street 1:PO BOX 731515
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1515
Mailing Address - Country:US
Mailing Address - Phone:484-351-8459
Mailing Address - Fax:484-351-8810
Practice Address - Street 1:100 FRONT STREET
Practice Address - Street 2:SUITE 280
Practice Address - City:WEST CONSHOHOCKEN
Practice Address - State:CA
Practice Address - Zip Code:19428-2891
Practice Address - Country:US
Practice Address - Phone:510-366-1567
Practice Address - Fax:484-351-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty