Healthcare Provider Details

I. General information

NPI: 1689312241
Provider Name (Legal Business Name): BROMEDICON PR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 AVE MUNOZ RIVERA
SAN JUAN PR
00918-3300
US

IV. Provider business mailing address

300 CONSHOHOCKEN STATE RD STE 450
CONSHOHOCKEN PA
19428-3801
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 Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: SANDRA L SILL
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 484-351-8459