Provider Demographics
NPI:1699191270
Name:JUN, INSU
Entity Type:Individual
Prefix:
First Name:INSU
Middle Name:
Last Name:JUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 GRAND AVE APT A9
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-6564
Mailing Address - Country:US
Mailing Address - Phone:551-655-9678
Mailing Address - Fax:
Practice Address - Street 1:166 GRAND AVE APT A9
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-6564
Practice Address - Country:US
Practice Address - Phone:551-655-9678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY605348163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse