Organization
PARK MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN BRUNNQUELL MD (DELEGATED OFFICIAL)
(201) 784-0123
Entity
Organization
Contact information
Practice address
24 ELM ST, HARRINGTON PARK, NJ 07640-1902
(201) 784-0123
Mailing address
24 ELM ST, HARRINGTON PARK, NJ 07640-1902
(201) 784-0123
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA05743400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0048302001
KEYSTONE GROUP #
NJ
01
—
0048302002
AMERIHEALTH GROUP # T
NJ
01
—
0048302004
AMERIHEALTH GROUP # NV
NJ
05
—
7298803
—
NJ
01
—
CB3927
RRMDCR GROUP #
NJ
Enumeration date
06/10/2006
Last updated
12/16/2009
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