Individual
AMY VAN BRUG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
2959 CHATHAM ST, PHILADELPHIA, PA 19134-4328
(908) 415-5603
Mailing address
2959 CHATHAM ST, PHILADELPHIA, PA 19134-4328
(908) 415-5603
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
09987
PA
Other
Enumeration date
04/09/2013
Last updated
11/09/2014
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