Healthcare Provider Details

I. General information

NPI: 1770415564
Provider Name (Legal Business Name): JANINE MARIE TUBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GARDEN CITY PLZ STE 350
GARDEN CITY NY
11530-3358
US

IV. Provider business mailing address

6 DUESENBERG DR
EAST NORWICH NY
11732-1106
US

V. Phone/Fax

Practice location:
  • Phone: 516-806-6969
  • Fax:
Mailing address:
  • Phone: 516-695-6242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number96082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: