Provider Demographics
NPI:1932706322
Name:FUNCTIONAL MEDICINE PRACTICE ASSOCIATES, PA
Entity Type:Organization
Organization Name:FUNCTIONAL MEDICINE PRACTICE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZIPP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-971-7257
Mailing Address - Street 1:435 SOUTH STREET
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-971-6301
Mailing Address - Fax:973-290-7169
Practice Address - Street 1:435 SOUTH STREET
Practice Address - Street 2:SUITE 160
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-971-6301
Practice Address - Fax:973-290-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty