Healthcare Provider Details

I. General information

NPI: 1487346151
Provider Name (Legal Business Name): MARY ELLEN ZUNG BA, CHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 WILLIAM ST
BOONTON NJ
07005-1821
US

IV. Provider business mailing address

318 WILLIAM ST
BOONTON NJ
07005-1821
US

V. Phone/Fax

Practice location:
  • Phone: 973-617-6742
  • Fax:
Mailing address:
  • Phone: 973-617-6742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: