Provider Demographics
NPI:1346257581
Name:CUBELLI, KEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:
Last Name:CUBELLI
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 1:109 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2776
Mailing Address - Country:US
Mailing Address - Phone:973-625-1221
Mailing Address - Fax:973-625-1594
Practice Address - Street 1:109 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2776
Practice Address - Country:US
Practice Address - Phone:973-625-1221
Practice Address - Fax:973-625-1594
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA38394207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF00223Medicare UPIN
NJCU472514Medicare ID - Type Unspecified