Provider Demographics
NPI:1336329242
Name:TUBINISGLODOWSKI, JANE MARGARET (MS RD CDN)
Entity Type:Individual
Prefix:MR
First Name:JANE
Middle Name:MARGARET
Last Name:TUBINISGLODOWSKI
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:MISS
Other - First Name:JANE
Other - Middle Name:MARGARET
Other - Last Name:TUBINIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RD
Mailing Address - Street 1:303 93RD ST APT B1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6913
Mailing Address - Country:US
Mailing Address - Phone:718-833-3767
Mailing Address - Fax:
Practice Address - Street 1:303 93RD ST APT B1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6913
Practice Address - Country:US
Practice Address - Phone:718-833-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY702127133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered