Provider Demographics
NPI:1154321701
Name:BUNDENS, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:BUNDENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 S DELSEA DR STE C
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5306
Mailing Address - Country:US
Mailing Address - Phone:856-690-1616
Mailing Address - Fax:856-896-6107
Practice Address - Street 1:800 JESSUP RD STE 809
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08086-9354
Practice Address - Country:US
Practice Address - Phone:856-690-1616
Practice Address - Fax:856-896-6107
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO4949900174400000X
NJ25MA04949900207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ337390801Medicaid
NJBU510247Medicare ID - Type Unspecified
NJ337390801Medicaid