Provider Demographics
NPI:1902902265
Name:ROBERT E BRUNNER INC
Entity Type:Organization
Organization Name:ROBERT E BRUNNER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUER
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:908-232-8182
Mailing Address - Street 1:100 EAST BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2112
Mailing Address - Country:US
Mailing Address - Phone:908-232-8182
Mailing Address - Fax:908-232-5727
Practice Address - Street 1:100 EAST BROAD STREET
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2112
Practice Address - Country:US
Practice Address - Phone:908-232-8182
Practice Address - Fax:908-232-5727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00078500156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0143860001Medicare NSC