Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | SC01303 | NJ |
NPI | 1003220468 |
---|---|
Provider Name | Mr. Edmund John Rung JR. |
First Address | Montclair, NJ 07042 |
Second Address | Montclair, NJ 07042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2014 |
Last Update Date | 13/06/2014 |