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	:	1455 BROAD ST STE 250
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-3066
Country	:	US
Telephone Number	:	775-327-8378
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 MOUNTS CORNER DR
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-2547
Country	:	US
Telephone Number	:	732-307-8408
Fax Number	:

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

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	03/13/2025

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