Provider Demographics
NPI:1437585312
Name:DUBLIN-PAVON, MARIETTA (NP)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:
Last Name:DUBLIN-PAVON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2633
Mailing Address - Country:US
Mailing Address - Phone:201-503-1000
Mailing Address - Fax:201-568-4300
Practice Address - Street 1:106 W PALISADE AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2633
Practice Address - Country:US
Practice Address - Phone:201-503-1000
Practice Address - Fax:201-568-4300
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJP00517100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily