Provider Demographics
NPI:1336247378
Name:BRUNSON, RODNEY C (DO)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:C
Last Name:BRUNSON
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 1:201 TILTON RD STE 12
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1247
Mailing Address - Country:US
Mailing Address - Phone:609-484-7000
Mailing Address - Fax:609-484-1533
Practice Address - Street 1:201 TILTON RD STE 12
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1247
Practice Address - Country:US
Practice Address - Phone:609-484-7000
Practice Address - Fax:609-484-1533
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05830400207QA0401X
NJMB058304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG35405Medicare UPIN