Provider Demographics
NPI:1205023660
Name:NINA L. TUBILLEJA, MD, P.C.
Entity Type:Organization
Organization Name:NINA L. TUBILLEJA, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:LAPIDARIO
Authorized Official - Last Name:TUBILLEJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-971-9392
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06960000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8001901Medicaid
NJG40202Medicare UPIN
NJ8001901Medicaid