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1851296008 NPI number — DIAMETABOLICARE PLLC

NPI Number: 1851296008
Health Care Provider/Practitioner: DIAMETABOLICARE PLLC

Information about “1851296008” NPI (DIAMETABOLICARE PLLC) exists in 1851296008 in HTML format HTML  |  1851296008 in plain Text format TXT  |  1851296008 in PDF (Portable Document Format) PDF  |  1851296008 in an XML format XML  formats.

NPI Number : 1851296008 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1851296008",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DIAMETABOLICARE PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "23 CENTER BEACH AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OLD LYME",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06371-2006",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "860-209-6086",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "23 CENTER BEACH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OLD LYME",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06371-2006",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "860-209-6086",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/08/2026",
    "LastUpdateDate": "10/08/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KUBACKA",
    "AuthorizedOfficialFirstName": "BEATA",
    "AuthorizedOfficialMiddleName": "T",
    "AuthorizedOfficialTitle": "SOLE MEMBER/MANAGER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DNP, AGPCNP-BC, RDN",
    "AuthorizedOfficialTelephoneNumber": "860-209-6086",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363L00000X",
        "TaxonomyName": "Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "NULL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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