Healthcare Provider Details

I. General information

NPI: 1851371983
Provider Name (Legal Business Name): DONNA DIBRUNO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MEDICAL CENTER DR SUITE E
SEWELL NJ
08080-2362
US

IV. Provider business mailing address

400 MEDICAL CENTER DR SUITE E
SEWELL NJ
08080-2362
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-5678
  • Fax: 856-582-8868
Mailing address:
  • Phone: 856-582-5678
  • Fax: 856-582-8868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MB07368600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMB07368600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: