Individual
JOEL GUNDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
411 W 52ND ST APT 2A, NEW YORK, NY 10019-5637
(917) 456-4704
Mailing address
411 W 52ND ST APT 2A, NEW YORK, NY 10019-5637
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
3243538953
NY
Other
Enumeration date
08/21/2020
Last updated
08/21/2020
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