Provider Demographics
NPI:1932144847
Name:BRUMBERG, MILES A (DO)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:A
Last Name:BRUMBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1748
Mailing Address - Country:US
Mailing Address - Phone:856-582-0470
Mailing Address - Fax:856-582-4664
Practice Address - Street 1:601 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-1748
Practice Address - Country:US
Practice Address - Phone:856-582-0470
Practice Address - Fax:856-582-4664
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03344200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ117420701Medicaid
NJ089366Medicare ID - Type Unspecified
NJEO6145Medicare UPIN