Healthcare Provider Details

I. General information

NPI: 1003321316
Provider Name (Legal Business Name): BROMEDICON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CONSHOHOCKEN STATE RD STE 450
CONSHOHOCKEN PA
19428-3801
US

IV. Provider business mailing address

1141 N LOOP 1604 E STE 105-484
SAN ANTONIO TX
78232-1339
US

V. Phone/Fax

Practice location:
  • Phone: 484-351-8459
  • Fax: 484-351-8810
Mailing address:
  • Phone: 484-351-8459
  • Fax: 484-351-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHEN HOUFF
Title or Position: PRESIDENT
Credential: MD
Phone: 484-351-8459