Provider Demographics
NPI:1861488736
Name:MEDUNICK, DAVID M (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:MEDUNICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:532 LAFAYETTE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-4411
Mailing Address - Country:US
Mailing Address - Phone:973-940-0423
Mailing Address - Fax:973-940-0399
Practice Address - Street 1:89 SPARTA AVE
Practice Address - Street 2:STE 100
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1777
Practice Address - Country:US
Practice Address - Phone:973-729-2121
Practice Address - Fax:973-729-3454
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2011-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB07739200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0072788Medicaid
NJ0072788Medicaid
I21946Medicare UPIN