Provider Demographics
NPI:1144291196
Name:TUBILLEJA, NINA LAPIDARIO (MD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:LAPIDARIO
Last Name:TUBILLEJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1051
Mailing Address - Country:US
Mailing Address - Phone:609-971-9392
Mailing Address - Fax:609-971-8232
Practice Address - Street 1:403 PENN AVE
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1051
Practice Address - Country:US
Practice Address - Phone:609-971-9392
Practice Address - Fax:609-971-8232
Is Sole Proprietor?:No
Enumeration Date:2006-01-29
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06960000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine