Healthcare Provider Details

I. General information

NPI: 1902950546
Provider Name (Legal Business Name): EUGENE BUBIS ND, LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 WALNUT ST SUITE 12
NEWTON HIGHLANDS MA
02461-1265
US

IV. Provider business mailing address

1163 WALNUT ST SUITE 12
NEWTON HIGHLANDS MA
02461-1265
US

V. Phone/Fax

Practice location:
  • Phone: 617-965-1181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1911
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1911
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1019
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: