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General NPI Number Information
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NPI Number | 1689312241
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Entity Type | Organization
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Legal Business Name | BROMEDICON PR INC
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 500 AVE MUNOZ RIVERA
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City | SAN JUAN
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State | PR
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Zip | 00918-3300
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Country | US
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Telephone | 484-351-8459
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Fax | 484-351-8810
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Provider Business Mailing Address
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Address Line | 100 FRONT ST STE 280
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-2891
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Country | US
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Telephone | 484-351-8459
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Fax | 484-351-8810
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | SANDRA L SILL
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Credential |
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Telephone | 484-351-8459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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