MEDICARE: MRS. BETSY ROCHELLE DUBOV REGISTERED DIETITIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1005X	Renal Nutrition Registered Dietitian	634638	NJ
2	133VN1005X	Renal Nutrition Registered Dietitian	634638	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	053650	OTHER	NJ	PROVIDER NUMBER

General Provider Information

NPI Number	:	1386817856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETSY ROCHELLE DUBOV REGISTERED DIETITIAN

Provider Business Mailing Address
First Line	:	331 NEWMAN SPRINGS RD STE 220
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-5792
Country	:	US
Telephone Number	:	732-807-0877
Fax Number	:	201-751-1680

Provider Business Practice Location Address
First Line	:	8 OLD BRIDGE TPKE STE 7
Second Line	:
City	:	SOUTH RIVER
State	:	NJ
Zip	:	08882-2400
Country	:	US
Telephone Number	:	732-390-4888
Fax Number	:	732-390-0255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2008
Last Update Date	:	11/15/2024

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