Provider Demographics
NPI:1508956905
Name:SHUBECK, CAROLINE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ANN
Last Name:SHUBECK
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 1:134 WESTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2256
Mailing Address - Country:US
Mailing Address - Phone:973-635-6354
Mailing Address - Fax:973-701-9516
Practice Address - Street 1:190 PARK AVE
Practice Address - Street 2:ST. ANNE VILLA
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1049
Practice Address - Country:US
Practice Address - Phone:973-867-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05890300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF88866Medicare UPIN
054558Medicare PIN