Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MB058304 | NJ |
N | 207QA0401X | Family Doctor - Addiction Medicine | 25MB05830400 | NJ |
NPI | 1336247378 |
---|---|
Provider Name | Dr. Rodney C Brunson |
First Address | Northfield, NJ 08225-1247 |
Second Address | Northfield, NJ 08225-1247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 11/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G35405 | (02) | NJ |