MEDICARE: BRANDON J HOM PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	25MP00376300	NJ

General Provider Information

NPI Number	:	1477921971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON J HOM PA-C

Provider Business Mailing Address
First Line	:	206 JACK MARTIN BLVD STE C2
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-7770
Country	:	US
Telephone Number	:	732-840-8402
Fax Number	:	732-840-8407

Provider Business Practice Location Address
First Line	:	206 JACK MARTIN BLVD STE C2
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-7770
Country	:	US
Telephone Number	:	732-840-8402
Fax Number	:	732-840-8407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	03/23/2026

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