Provider Demographics
NPI:1760739775
Name:VANDA BRUNER MD PA
Entity Type:Organization
Organization Name:VANDA BRUNER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-946-7951
Mailing Address - Street 1:23 COUNTRY SQUIRE LN
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2369
Mailing Address - Country:US
Mailing Address - Phone:732-946-7951
Mailing Address - Fax:
Practice Address - Street 1:719 N BEERS ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1522
Practice Address - Country:US
Practice Address - Phone:732-264-4646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA570982080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty