Basic Information
| Provider Information | |||||||||
| NPI: | 1851371983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIBRUNO | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 400 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080802362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565825678 | ||||||||
| FaxNumber: | 8565828868 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE E | ||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080802362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565825678 | ||||||||
| FaxNumber: | 8565828868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 06/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MB07368600 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0006751 | 05 | NJ | MEDICAID |