Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 25MAO4099300 | NJ |
Y | 111NI0900X | Internist | 25MAO4099300 | NJ |
N | 207RA0401X | Internist - Addiction Medicine | 25MAO4099300 | NJ |
NPI | 1699949305 |
---|---|
Provider Name | Dr. Jon William Brunswick |
First Address | Livingston, NJ 07039-2414 |
Second Address | Livingston, NJ 07039-2414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2008 |
Last Update Date | 15/04/2008 |