Provider Demographics
NPI:1699874461
Name:BRUNT, JOSEPH F (PA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:F
Last Name:BRUNT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20-24 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-1710
Mailing Address - Country:US
Mailing Address - Phone:607-772-6161
Mailing Address - Fax:607-772-6138
Practice Address - Street 1:20-24 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1710
Practice Address - Country:US
Practice Address - Phone:607-772-6161
Practice Address - Fax:607-772-6138
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007107363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP17020Medicare UPIN
NYDD1564Medicare ID - Type Unspecified