Provider Demographics
NPI:1508297862
Name:CUBERO, ANGELA ELSIE (MSOM, L AC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:ELSIE
Last Name:CUBERO
Suffix:
Gender:F
Credentials:MSOM, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 RIVER RD STE 209
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1522
Mailing Address - Country:US
Mailing Address - Phone:201-220-7055
Mailing Address - Fax:201-881-0222
Practice Address - Street 1:335 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1826
Practice Address - Country:US
Practice Address - Phone:201-220-7055
Practice Address - Fax:201-881-0222
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005098-1171100000X
NJ0052098-1171100000X
NY0052098-1175F00000X
NJ25MZ00103900171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath