1740973064 NPI number — DUNDON ORTHOPEDICS AND SPORTS MEDICINE

Table of content: MARCIA KAY MCCULLEY WHNP (NPI 1326106774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740973064 NPI number — DUNDON ORTHOPEDICS AND SPORTS MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUNDON ORTHOPEDICS AND SPORTS MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740973064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 POND VIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07930-3123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
465 UNION AVE STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEWATER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08807-3196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-288-1393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2023

Additional Information

Authorized Official

Authorized Official Last Name:
DUNDON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
ORTHOPEDIC SURGEON
Authorized Official Telephone Number:
614-288-1393

Provider Taxonomy Codes

  • Taxonomy code: 207XS0114X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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