Healthcare Provider Details

I. General information

NPI: 1508892829
Provider Name (Legal Business Name): LAURIE R. BRUNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE A. REID

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 HURFFVILLE CROSSKEYS RD STE 203
SEWELL NJ
08080-9344
US

IV. Provider business mailing address

405 HURFFVILLE CROSSKEYS RD STE 203
SEWELL NJ
08080-9344
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-0033
  • Fax: 856-582-2305
Mailing address:
  • Phone: 856-582-0033
  • Fax: 856-582-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07235100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: