Healthcare Provider Details

I. General information

NPI: 1477921971
Provider Name (Legal Business Name): BRANDON J HOM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 JACK MARTIN BLVD STE C2
BRICK NJ
08724-7770
US

IV. Provider business mailing address

206 JACK MARTIN BLVD STE C2
BRICK NJ
08724-7770
US

V. Phone/Fax

Practice location:
  • Phone: 732-840-8402
  • Fax: 732-840-8407
Mailing address:
  • Phone: 732-840-8402
  • Fax: 732-840-8407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00376300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: