Provider Demographics
NPI:1942216874
Name:BRUNNER, STEVEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:BRUNNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:241 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2924
Mailing Address - Country:US
Mailing Address - Phone:631-367-5300
Mailing Address - Fax:631-351-4561
Practice Address - Street 1:241 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2924
Practice Address - Country:US
Practice Address - Phone:631-367-5300
Practice Address - Fax:631-351-4561
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229156-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2695852OtherGHI
NY3C6485OtherHEALTHNET
NY605Z61OtherBLUE CROSS/ BLUE SHIELD
NY02601476Medicaid
NYP3344549OtherOXFORD
NYI21289Medicare UPIN
NYP3344549OtherOXFORD