Provider Demographics
NPI:1851385280
Name:BREUNIG, JOANNA F (PAC)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:F
Last Name:BREUNIG
Suffix:
Gender:
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 TECHNOLOGY DR UNIT C301
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6368
Mailing Address - Country:US
Mailing Address - Phone:203-268-4884
Mailing Address - Fax:203-268-8674
Practice Address - Street 1:115 TECHNOLOGY DR UNIT C301
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6368
Practice Address - Country:US
Practice Address - Phone:203-268-4884
Practice Address - Fax:203-268-8674
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S52590Medicare UPIN