Provider Demographics
NPI:1720224512
Name:BRUNJES, RAYMOND J (RPT)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:J
Last Name:BRUNJES
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4301
Mailing Address - Country:US
Mailing Address - Phone:516-678-2182
Mailing Address - Fax:516-608-0755
Practice Address - Street 1:269 ARCH ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-4301
Practice Address - Country:US
Practice Address - Phone:516-678-2182
Practice Address - Fax:516-608-0755
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-28
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5421252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5421OtherPHYSICAL THERAPIST