Provider Demographics
NPI:1710046099
Name:MUNDORFF, CURT W (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:MR
First Name:CURT
Middle Name:W
Last Name:MUNDORFF
Suffix:
Gender:M
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SOUTH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1364
Mailing Address - Country:US
Mailing Address - Phone:908-889-7900
Mailing Address - Fax:908-889-6003
Practice Address - Street 1:313 SOUTH AVE STE 205
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1364
Practice Address - Country:US
Practice Address - Phone:908-889-7900
Practice Address - Fax:908-889-6003
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00674200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ072432R32Medicare ID - Type Unspecified