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General NPI Number Information
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NPI Number | 1851296008
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Entity Type | Organization
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Legal Business Name | DIAMETABOLICARE PLLC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 23 CENTER BEACH AVE
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City | OLD LYME
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State | CT
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Zip | 06371-2006
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Country | US
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Telephone | 860-209-6086
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Fax |
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Provider Business Mailing Address
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Address Line | 23 CENTER BEACH AVE
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City | OLD LYME
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State | CT
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Zip | 06371-2006
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Country | US
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Telephone | 860-209-6086
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER/MANAGER
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Name | DR. BEATA T KUBACKA
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Credential | DNP, AGPCNP-BC, RDN
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Telephone | 860-209-6086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | NULL
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