Healthcare Provider Details

I. General information

NPI: 1912098187
Provider Name (Legal Business Name): CHRISTOPHER HUBBARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 HAMBURG TPKE STE 100
WAYNE NJ
07470-3235
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 973-616-0200
  • Fax: 973-616-1792
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number201777
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number25MA07184700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: