Healthcare Provider Details

I. General information

NPI: 1851296008
Provider Name (Legal Business Name): DIAMETABOLICARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CENTER BEACH AVE
OLD LYME CT
06371-2006
US

IV. Provider business mailing address

23 CENTER BEACH AVE
OLD LYME CT
06371-2006
US

V. Phone/Fax

Practice location:
  • Phone: 860-209-6086
  • Fax:
Mailing address:
  • Phone: 860-209-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BEATA T KUBACKA
Title or Position: SOLE MEMBER/MANAGER
Credential: DNP, AGPCNP-BC, RDN
Phone: 860-209-6086