Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 011764-1 | NY |
N | 2251S0007X | Physical Therapist - Sports | 011764-1 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 011764-1 | NY |
NPI | 1144391202 |
---|---|
Provider Name | Mr. Michael Matthew Brunner |
First Address | Endicott, NY 13760-3828 |
Second Address | Vestal, NY 13850-3640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000089686 | GHI-HMO (01) | NY |
02252115 | (05) | NY |
10055823 | CDPHP (01) | NY |
3962334 | AETNA-HMO (01) | NY |
438126 | MVP (01) | NY |
4552539 | AETNA (01) | NY |
4552539 | AETNA-EPO (01) | NY |
64-01196 | UHC-PPO (01) | NY |
6697062 | GHI-PPO (01) | NY |
9976077625901 | GEICO (01) | NY |
G0186259040 | MONROE (01) | NY |