Provider Demographics
NPI:1639878333
Name:CHUNG, ANDREW (PTA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CHUNG
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 1:241 FORSGATE DR STE 114
Mailing Address - Street 2:
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1385
Mailing Address - Country:US
Mailing Address - Phone:848-219-4948
Mailing Address - Fax:
Practice Address - Street 1:241 FORSGATE DR STE 114
Practice Address - Street 2:
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1385
Practice Address - Country:US
Practice Address - Phone:848-219-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00347700225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant