Basic Information
| Provider Information | |||||||||
| NPI: | 1801076773 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUNNICELLI | ||||||||
| FirstName: | JOSEPHINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 197 8TH ST | ||||||||
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| City: | BELFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077181440 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 380 DEMOTT LN | ||||||||
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| City: | SOMERSET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088732762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328732000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2007 | ||||||||
| LastUpdateDate: | 08/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 025276-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 40QA01080000 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.