Basic Information
Provider Information
NPI: 1336303973
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRUNHOEBER
FirstName: PATRICK
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7111 FAIRWAY DR
Address2: SUITE 400
City: PALM BEACH GARDENS
State: FL
PostalCode: 334184204
CountryCode: US
TelephoneNumber: 8003306565
FaxNumber: 5617127349
Practice Location
Address1: 100 MIDLAND AVE
Address2:  
City: PORT CHESTER
State: NY
PostalCode: 105734943
CountryCode: US
TelephoneNumber: 8009423376
FaxNumber: 9149349819
Other Information
ProviderEnumerationDate: 07/14/2008
LastUpdateDate: 07/14/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZD0900X249436NYY Allopathic & Osteopathic PhysiciansPathologyDermatopathology
207ZP0102X249436NYN Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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