Provider Demographics
NPI:1245205376
Name:FAN, SCHUBER C (MD)
Entity Type:Individual
Prefix:DR
First Name:SCHUBER
Middle Name:C
Last Name:FAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MAPLE AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1734
Mailing Address - Country:US
Mailing Address - Phone:732-741-1378
Mailing Address - Fax:732-741-1677
Practice Address - Street 1:130 MAPLE AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1734
Practice Address - Country:US
Practice Address - Phone:732-741-1378
Practice Address - Fax:732-741-1677
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA277342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1003402Medicaid
NJ0619012543OtherHORIZON
NJ0004256293OtherAETNA
NJC59154Medicare UPIN
NJ0004256293OtherAETNA