Provider Demographics
NPI:1740281310
Name:BRUNNQUELL, STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:BRUNNQUELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1902
Mailing Address - Country:US
Mailing Address - Phone:201-784-0123
Mailing Address - Fax:201-784-0065
Practice Address - Street 1:24 ELM ST
Practice Address - Street 2:
Practice Address - City:HARRINGTON PARK
Practice Address - State:NJ
Practice Address - Zip Code:07640-1902
Practice Address - Country:US
Practice Address - Phone:201-784-0123
Practice Address - Fax:201-784-0065
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05743400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBP241OtherOXFORD ID #
NJ0048232000OtherAMERIHEALTH ID #
NJ4273266OtherAETNA ID #
NJ0048302001OtherKEYSTONE #
NJ17L231OtherEMPIRE HC (HP)
NJ0K6753OtherHEALTHNET ID #
NJ110163804OtherRAILROAD MDCR #
NJ5362202Medicaid
NJ17L232OtherEMPIRE HC (TE)
NJ17L233OtherEMPIRE HC (NV)
NJ110163804OtherRAILROAD MDCR #
NJ5362202Medicaid