MEDICARE: ARLENE GUNGON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	14785	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20-4605075	OTHER		MEDICARE B

General Provider Information

NPI Number	:	1497146658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLENE GUNGON

Provider Business Mailing Address
First Line	:	201 S MAIN ST
Second Line	:	BLDG LOST A
City	:	LAMBERTVILLE
State	:	NJ
Zip	:	08530-1800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 EMERALD POND LN
Second Line	:	BLDG LOST A
City	:	DURHAM
State	:	NC
Zip	:	27705-6051
Country	:	US
Telephone Number	:	919-475-4041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	02/10/2015

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