Provider Demographics
NPI:1356697403
Name:BUNN, THEODORE III
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:BUNN
Suffix:III
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 1:1050 KINGS HWY N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1909
Mailing Address - Country:US
Mailing Address - Phone:856-438-5354
Mailing Address - Fax:856-438-5691
Practice Address - Street 1:1050 KINGS HWY N
Practice Address - Street 2:SUITE 101
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1909
Practice Address - Country:US
Practice Address - Phone:856-438-5354
Practice Address - Fax:856-438-5691
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00106700237700000X
PAF03222237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist