Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 25MA02742400 | NJ |
NPI | 1053317636 |
---|---|
Provider Name | Dr. Bruce J. Brener |
First Address | Livingston, NJ 07039-5817 |
Second Address | Livingston, NJ 07039-5817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1812408 | (05) | NJ |
D96530 | (02) | NJ |