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NPI Code Detail

MEDICARE: CHRISTINE JESSICA LUBY

MEDICARE:   CHRISTINE JESSICA LUBY
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
1133NN1002XNutrition Education NutritionistDN005840PA
2133N00000XNutritionistDN005840PA

General Provider Information

NPI Number : 1699374413
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE JESSICA LUBY
Provider Business Mailing Address
First Line : 2450 W HUNTING PARK AVE FL 2
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19129-1302
Country : US
Telephone Number : 215-926-9019
Fax Number :
Provider Business Practice Location Address
First Line : 7500 CENTRAL AVE STE 104
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19111-2431
Country : US
Telephone Number : 215-742-0712
Fax Number : 215-742-5218
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2020
Last Update Date : 10/22/2020

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Directions to “ CHRISTINE JESSICA LUBY ” Practice Location

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