Provider Demographics
NPI:1386817856
Name:DUBOV, BETSY ROCHELLE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:ROCHELLE
Last Name:DUBOV
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OLD BRIDGE TPKE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-2400
Mailing Address - Country:US
Mailing Address - Phone:732-390-4888
Mailing Address - Fax:732-238-9509
Practice Address - Street 1:8 OLD BRIDGE TPKE
Practice Address - Street 2:
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-2400
Practice Address - Country:US
Practice Address - Phone:732-390-4888
Practice Address - Fax:732-390-9685
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL634638133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ053650OtherPROVIDER NUMBER
NJ053650OtherPROVIDER NUMBER