Provider Demographics
NPI:1841914264
Name:SHUNG, NADIA NATASHA I (LMT)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:NATASHA
Last Name:SHUNG
Suffix:I
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BERGEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-4725
Mailing Address - Country:US
Mailing Address - Phone:646-597-2117
Mailing Address - Fax:
Practice Address - Street 1:204 2ND ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3735
Practice Address - Country:US
Practice Address - Phone:201-420-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00459200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist