Provider Demographics
NPI:1518376904
Name:MUNN, ERIC ANDREW (PTA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ANDREW
Last Name:MUNN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:6 STROWBRIDGE AVENUE
Mailing Address - City:MOUNT TABOR
Mailing Address - State:NJ
Mailing Address - Zip Code:07878-0502
Mailing Address - Country:US
Mailing Address - Phone:973-586-1693
Mailing Address - Fax:
Practice Address - Street 1:77 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7330
Practice Address - Country:US
Practice Address - Phone:973-540-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00310200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant