Healthcare Provider Details

I. General information

NPI: 1811224827
Provider Name (Legal Business Name): EDWARD GERARD DI BRUNO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 S 13TH ST
PHILADELPHIA PA
19148-5235
US

IV. Provider business mailing address

3130 S 13TH ST
PHILADELPHIA PA
19148-5235
US

V. Phone/Fax

Practice location:
  • Phone: 267-973-2649
  • Fax:
Mailing address:
  • Phone: 267-973-2649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN288712L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: