MEDICARE: MARIE DUBIEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40QA00551400	OTHER	NJ	LICENSE #

General Provider Information

NPI Number	:	1538276043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE DUBIEL

Provider Business Mailing Address
First Line	:	94 PHEASANT RUN
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-2943
Country	:	US
Telephone Number	:	732-452-1476
Fax Number	:

Provider Business Practice Location Address
First Line	:	904 OAK TREE AVE STE S
Second Line	:
City	:	SOUTH PLAINFIELD
State	:	NJ
Zip	:	07080-5126
Country	:	US
Telephone Number	:	908-756-6555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/08/2007

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