Provider Demographics
NPI:1780059196
Name:MUNDEN, XAVIER
Entity type:Individual
Prefix:
First Name:XAVIER
Middle Name:
Last Name:MUNDEN
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 1:380 MOUNT PROSPECT AVE APT 8C
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2141
Mailing Address - Country:US
Mailing Address - Phone:757-582-4763
Mailing Address - Fax:
Practice Address - Street 1:380 MOUNT PROSPECT AVE APT 8C
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2141
Practice Address - Country:US
Practice Address - Phone:757-582-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist