Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA05709800 | NJ |
NPI | 1023066305 |
---|---|
Provider Name | Dr. Vanda Bruner |
First Address | Holmdel, NJ 07733-1522 |
Second Address | Holmdel, NJ 07733-1522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |