1912012501 NPI number — MRS. ROSEMARY BRUCH MS

Table of content: MRS. ROSEMARY BRUCH MS (NPI 1912012501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912012501 NPI number — MRS. ROSEMARY BRUCH MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUCH
Provider First Name:
ROSEMARY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912012501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 FORSGATE DRIVE FORSGATE COMMONS
Provider Second Line Business Mailing Address:
PENTA HEARING CARE
Provider Business Mailing Address City Name:
JAMESBURG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-656-7701
Provider Business Mailing Address Fax Number:
732-656-7703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 FORSGATE DRIVE FORSGATE COMMONS
Provider Second Line Business Practice Location Address:
PENTA HEARING CARE
Provider Business Practice Location Address City Name:
JAMESBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-656-7701
Provider Business Practice Location Address Fax Number:
732-656-7703
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  41YA00000700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 237600000X , with the licence number: 25MG00051400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ME5096 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2220106000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30434426 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5424585 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0053333 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0840805 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2288549 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".




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