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General NPI Number Information
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NPI Number | 1568021640
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Entity Type | Individual
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Provider Name | GABRIELLE MARIE BRUNO PA
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Gender | Female
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 2099 NEW ALBANY RD
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City | CINNAMINSON
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State | NJ
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Zip | 08077-3534
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Country | US
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Telephone | 609-926-8899
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Fax | 856-772-1997
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Provider Business Mailing Address
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Address Line | 209 LAMP POST LN
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City | CHERRY HILL
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State | NJ
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Zip | 08003-1313
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Country | US
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Telephone | 201-320-5499
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00523700
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License Number State | NJ
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