Healthcare Provider Details

I. General information

NPI: 1316585375
Provider Name (Legal Business Name): DEBRA JILL CIUBA DNP, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 US HIGHWAY 9
HOWELL NJ
07731-3380
US

IV. Provider business mailing address

6 MANNING CT
GALLOWAY NJ
08205-4217
US

V. Phone/Fax

Practice location:
  • Phone: 732-987-8200
  • Fax: 732-987-5964
Mailing address:
  • Phone: 908-380-6351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ01000400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: