Provider Demographics
NPI:1962586073
Name:BRONNER, GURI (MD)
Entity type:Individual
Prefix:DR
First Name:GURI
Middle Name:
Last Name:BRONNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 C G ZINN RD
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1134
Mailing Address - Country:US
Mailing Address - Phone:610-384-9100
Mailing Address - Fax:610-384-3937
Practice Address - Street 1:3000 C G ZINN RD
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1134
Practice Address - Country:US
Practice Address - Phone:610-384-9100
Practice Address - Fax:610-384-3937
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39738207W00000X
NJ25MA08200800207W00000X
PAMD437353207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0135585Medicaid
PA102306503-0001Medicaid
NJ112385CY6Medicare PIN
PA102306503-0001Medicaid
I30352Medicare UPIN
NJ0135585Medicaid
PA155053G69Medicare PIN