=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396946562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EUGENIE BRUNNER, M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 256 BUNN DR.
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-921-9497
-----------------------------------------------------
Fax | 609-921-7040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 256 BUNN DR.
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-921-9497
-----------------------------------------------------
Fax | 609-921-7040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D.
-----------------------------------------------------
Name | EUGENIE BRUNNER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 609-921-9497
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 207YX0905X
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------