Provider Demographics
NPI:1699949305
Name:BRUNSWICK, JON WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:WILLIAM
Last Name:BRUNSWICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MURRAY
Other - Middle Name:
Other - Last Name:LAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9 THURSTON DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2414
Mailing Address - Country:US
Mailing Address - Phone:973-994-4694
Mailing Address - Fax:973-625-6184
Practice Address - Street 1:9 THURSTON DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2414
Practice Address - Country:US
Practice Address - Phone:973-994-4694
Practice Address - Fax:973-625-6184
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO4099300207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine