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General NPI Number Information
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NPI Number | 1023370855
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Entity Type | Organization
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Legal Business Name | CHRISTINE FUNG RD LLC
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 123 DUNHAMS CORNER RD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3500
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Country | US
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Telephone | 732-254-0113
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Fax |
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Provider Business Mailing Address
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Address Line | 217 ANN ST
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-5105
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Country | US
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Telephone | 908-229-5436
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CHRISTINE FUNG
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Credential | RD
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Telephone | 908-229-5436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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