Provider Demographics
NPI:1073702049
Name:NUBI, MICHEAL O
Entity Type:Individual
Prefix:
First Name:MICHEAL
Middle Name:O
Last Name:NUBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CEDARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4887
Mailing Address - Country:US
Mailing Address - Phone:732-500-7149
Mailing Address - Fax:
Practice Address - Street 1:4 CEDARVIEW AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4887
Practice Address - Country:US
Practice Address - Phone:732-500-7149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA06692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist