Healthcare Provider Details

I. General information

NPI: 1578630281
Provider Name (Legal Business Name): PAUL LJUBICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 BETHEL RD SUITE E
SOMERS POINT NJ
08244-2172
US

IV. Provider business mailing address

408 BETHEL RD SUITE E
SOMERS POINT NJ
08244-2172
US

V. Phone/Fax

Practice location:
  • Phone: 609-926-3330
  • Fax: 609-926-9033
Mailing address:
  • Phone: 609-926-3330
  • Fax: 609-926-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMA057692
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: