Basic Information
| Provider Information | |||||||||
| NPI: | 1912012501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUCH | ||||||||
| FirstName: | ROSEMARY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 241 FORSGATE DRIVE FORSGATE COMMONS | ||||||||
| Address2: | PENTA HEARING CARE | ||||||||
| City: | JAMESBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326567701 | ||||||||
| FaxNumber: | 7326567703 | ||||||||
| Practice Location | |||||||||
| Address1: | 241 FORSGATE DRIVE FORSGATE COMMONS | ||||||||
| Address2: | PENTA HEARING CARE | ||||||||
| City: | JAMESBURG | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326567701 | ||||||||
| FaxNumber: | 7326567703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 41YA00000700 | NJ | X | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 25MG00051400 | NJ | X | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
ID Information
| ID | Type | State | Issuer | Description | ME5096 | 01 | UNITED HEALTH CARE | OTHER | 2220106000 | 01 | AMERIHEALTH | OTHER | 30434426 | 01 | AETNA | OTHER | 5424585 | 01 | AETNA | OTHER | 0053333 | 05 | NJ | MEDICAID | 0840805 | 01 | CIGNA | OTHER | 2288549 | 01 | UNITED HEALTH CARE | OTHER |