MEDICARE: BRUIN NEUROPHYSIOLOGY, P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
2	2084N0400X	Neurology Physician
3	204R00000X	Electrodiagnostic Medicine Physician
4	2084N0600X	Clinical Neurophysiology Physician

General Provider Information

NPI Number	:	1710364112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUIN NEUROPHYSIOLOGY, P.C.

Provider Business Mailing Address
First Line	:	1141 N LOOP 1604 E STE 105-484
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1339
Country	:	US
Telephone Number	:	484-351-8459
Fax Number	:	484-351-8810

Provider Business Practice Location Address
First Line	:	100 FRONT STREET
Second Line	:	SUITE 280
City	:	WEST CONSHOHOCKEN
State	:	CA
Zip	:	19428-2891
Country	:	US
Telephone Number	:	510-366-1567
Fax Number	:	484-351-8810

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBIN SOFFER
Credential	:	M.D.
Telephone Number	:	484-351-8417

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	12/08/2025

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