Healthcare Provider Details

I. General information

NPI: 1023370855
Provider Name (Legal Business Name): CHRISTINE FUNG RD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 DUNHAMS CORNER RD
EAST BRUNSWICK NJ
08816-3500
US

IV. Provider business mailing address

217 ANN ST
HILLSBOROUGH NJ
08844-5105
US

V. Phone/Fax

Practice location:
  • Phone: 732-254-0113
  • Fax:
Mailing address:
  • Phone: 908-229-5436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINE FUNG
Title or Position: OWNER
Credential: RD
Phone: 908-229-5436