Provider Demographics
NPI:1114577798
Name:LUNGER, ANDREW (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LUNGER
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08827-2540
Mailing Address - Country:US
Mailing Address - Phone:908-892-1072
Mailing Address - Fax:
Practice Address - Street 1:536 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08827-2540
Practice Address - Country:US
Practice Address - Phone:908-892-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002264002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty