Provider Demographics
NPI:1912012501
Name:BRUCH, ROSEMARY (MS)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:
Last Name:BRUCH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 FORSGATE DRIVE FORSGATE COMMONS
Mailing Address - Street 2:PENTA HEARING CARE
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831
Mailing Address - Country:US
Mailing Address - Phone:732-656-7701
Mailing Address - Fax:732-656-7703
Practice Address - Street 1:241 FORSGATE DRIVE FORSGATE COMMONS
Practice Address - Street 2:PENTA HEARING CARE
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831
Practice Address - Country:US
Practice Address - Phone:732-656-7701
Practice Address - Fax:732-656-7703
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00000700231H00000X
NJ25MG00051400237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME5096OtherUNITED HEALTH CARE
2220106000OtherAMERIHEALTH
30434426OtherAETNA
5424585OtherAETNA
NJ0053333Medicaid
0840805OtherCIGNA
2288549OtherUNITED HEALTH CARE
NJ0053333Medicaid