MEDICARE: XAVIER MUNDEN

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	224Y00000X	Clinical Exercise Physiologist
2	225800000X	Recreation Therapist

General Provider Information

NPI Number	:	1780059196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XAVIER MUNDEN

Provider Business Mailing Address
First Line	:	380 MOUNT PROSPECT AVE APT 8C
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-2141
Country	:	US
Telephone Number	:	757-582-4763
Fax Number	:

Provider Business Practice Location Address
First Line	:	380 MOUNT PROSPECT AVE APT 8C
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-2141
Country	:	US
Telephone Number	:	757-582-4763
Fax Number	:

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

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/10/2015

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Directions to “ XAVIER MUNDEN ” Practice Location

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