Healthcare Provider Details

I. General information

NPI: 1932706322
Provider Name (Legal Business Name): FUNCTIONAL MEDICINE PRACTICE ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SOUTH STREET SUITE 160
MORRISTOWN NJ
07960
US

IV. Provider business mailing address

435 SOUTH STREET SUITE 160
MORRISTOWN NJ
07960
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-6301
  • Fax: 973-290-7169
Mailing address:
  • Phone: 973-971-6301
  • Fax: 973-290-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER P. ZIPP
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 937-971-7257