Provider Demographics
NPI:1437168432
Name:DAUB, DENISE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MARIE
Last Name:DAUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2012
Mailing Address - Country:US
Mailing Address - Phone:201-617-7771
Mailing Address - Fax:201-617-0470
Practice Address - Street 1:1808 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2012
Practice Address - Country:US
Practice Address - Phone:201-617-7771
Practice Address - Fax:201-617-0470
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ223029857208D00000X
NJ25MA05030500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE33565Medicare UPIN