Individual provider Active NPI

Laurie R. Bruner, MD

  • Pediatrics Physician
  • Sewell, NJ
National Provider Identifier
1508892829
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MA07235100 Issued in NJ
Practice address
405 Hurffville Crosskeys Rd Ste 203
Sewell, NJ 08080-9344
Phone
(856) 582-0033
Fax
(856) 582-2305
NPI assigned
Jun 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 25MA07235100 NJ Primary

Addresses

Primary practice location

405 Hurffville Crosskeys Rd Ste 203
Sewell, NJ 08080-9344

Mailing address

405 Hurffville Crosskeys Rd Ste 203
Sewell, NJ 08080-9344
Phone (856) 582-0033

Other practice location 1

1474 Tanyard Road
Suite D102
Sewell, NJ 08080
Phone (856) 566-7045

Other practice location 2

42 E Laurel Rd Ste 3500
Stratford, NJ 08084-1354
Phone (856) 566-7040

Other names 1

  • Laurie A. Reid Former name

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address lbruner18205@directvirtua.org
Direct Messaging Address lbruner18205@directvirtua.org
Direct Messaging Address lbruner18205@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201007000248 NJ Practitioner - Pediatric Medicine 5294978151 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA07235100NJMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA CurrentSince Jun 5, 2023 Accepting new patients
Children'S Healthcare Associates of New Jersey PC CurrentSince Aug 1, 2020 Accepting new patients
Childrens Health Care Associates of New Jersey PC Pediatrics Current Accepting new patients
Childens Health Care Associates of New Jersey PC CurrentSince Aug 1, 2020 Accepting new patients
Virtua Medical Group, PA CurrentSince Jun 5, 2023 Accepting new patients
Virtua - West Jersey Health System, Inc. Past Accepting new patients
Advocare, LLC Pediatrics Past Accepting new patients
Advocare, LLC Pediatrics Past Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

303 Lippincott Dr
Marlton, NJ 08053

175 Madison Ave
Mount Holly, NJ 08060
Phone (609) 261-1660

707 Alexander Rd
Princeton, NJ 08540
Phone (609) 520-1717

1474 Tanyard Rd
Ste D102
Sewell, NJ 08080
Phone (856) 566-7045

405 Hurffville Crosskeys Rd
Ste 203
Sewell, NJ 08080
Phone (856) 582-0033

42 E Laurel Rd
Ste 3500
Stratford, NJ 08084
Phone (856) 566-7040

42 E Laurel Rd
Ste 2500
Stratford, NJ 08084
Phone (856) 566-7040

200 Bowman Dr
Voorhees, NJ 08043
Phone (267) 425-5400

100 Bowman Dr
Voorhees, NJ 08043
Phone (856) 247-3000

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1508892829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 HURFFVILLE CROSSKEYS RD STE 203",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080809344",
            "telephone_number": "856-582-0033",
            "fax_number": "856-582-2305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 HURFFVILLE CROSSKEYS RD STE 203",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080809344",
            "telephone_number": "856-582-0033",
            "fax_number": "856-582-2305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1474 Tanyard Road",
            "address_2": "Suite D102",
            "address_purpose": "LOCATION",
            "city": "Sewell",
            "state": "NJ",
            "postal_code": "08080",
            "country_code": "US",
            "telephone_number": "856-566-7045",
            "fax_number": "856-566-6850",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "42 E Laurel Rd Ste 3500",
            "address_purpose": "LOCATION",
            "city": "Stratford",
            "state": "NJ",
            "postal_code": "080841354",
            "country_code": "US",
            "telephone_number": "856-566-7040",
            "fax_number": "856-566-6826",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUNER",
        "first_name": "LAURIE",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-26",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA07235100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lbruner18205@directvirtua.org",
            "affiliation": "N",
            "address_1": "42 E Laurel Rd Ste 2500",
            "city": "Stratford",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080841354",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lbruner18205@directvirtua.org",
            "affiliation": "N",
            "address_1": "405 Hurffville Crosskeys Rd Ste 203",
            "city": "Sewell",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080809344",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lbruner18205@directvirtua.org",
            "affiliation": "N",
            "address_1": "1474 Tanyard Road",
            "address_2": "Suite D102",
            "city": "Sewell",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "08080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LAURIE",
            "last_name": "REID",
            "middle_name": "A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sewell, NJ

Sources for this page

Verify at the official NPI Registry.