Basic Information
| Provider Information | |||||||||
| NPI: | 1790388833 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SUN | ||||||||
| FirstName: | XUN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 OVERLOOK DR | ||||||||
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| City: | WARREN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070595144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082511441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082734300 | ||||||||
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| ProviderEnumerationDate: | 11/20/2020 | ||||||||
| LastUpdateDate: | 11/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 26NJ01071000 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.