Healthcare Provider Details

I. General information

NPI: 1336247378
Provider Name (Legal Business Name): RODNEY C BRUNSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 TILTON RD STE 12
NORTHFIELD NJ
08225-1247
US

IV. Provider business mailing address

201 TILTON RD STE 12
NORTHFIELD NJ
08225-1247
US

V. Phone/Fax

Practice location:
  • Phone: 609-484-7000
  • Fax: 609-484-1533
Mailing address:
  • Phone: 609-484-7000
  • Fax: 609-484-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number25MB05830400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB058304
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: