MEDICARE: MS. G SANDRA BYER-LUBIN MS, RD, CDE

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	133V00000X	Registered Dietitian	R596554	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2143162	OTHER	NJ	AETNA
2	P2095526	OTHER	NJ	OXFORD

General Provider Information

NPI Number	:	1992832992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. G SANDRA BYER-LUBIN MS, RD, CDE

Provider Business Mailing Address
First Line	:	22 HIGHMONT DRIVE
Second Line	:
City	:	WEST WINDSOR
State	:	NJ
Zip	:	08550-3235
Country	:	US
Telephone Number	:	609-275-6237
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 ONE MILE RD EXT
Second Line	:
City	:	EAST WINDSOR
State	:	NJ
Zip	:	08520-2505
Country	:	US
Telephone Number	:	609-275-6237
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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