Provider Demographics
NPI:1487074266
Name:GUNSON, EILEEN (AT)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:GUNSON
Suffix:
Gender:F
Credentials:AT
Other - Prefix:MRS
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:GUNSON-BOWKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AT
Mailing Address - Street 1:5404 SOUTH LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLGATE
Mailing Address - State:NJ
Mailing Address - Zip Code:08008
Mailing Address - Country:US
Mailing Address - Phone:609-217-8232
Mailing Address - Fax:
Practice Address - Street 1:148 ARNEYS MOUNT RD
Practice Address - Street 2:
Practice Address - City:PEMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08068-1313
Practice Address - Country:US
Practice Address - Phone:609-893-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000294002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22Medicaid