Healthcare Provider Details

I. General information

NPI: 1386817856
Provider Name (Legal Business Name): BETSY ROCHELLE DUBOV REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 OLD BRIDGE TPKE STE 7
SOUTH RIVER NJ
08882-2400
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD STE 220
RED BANK NJ
07701-5792
US

V. Phone/Fax

Practice location:
  • Phone: 732-390-4888
  • Fax: 732-390-0255
Mailing address:
  • Phone: 732-807-0877
  • Fax: 201-751-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number634638
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number634638
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: