Provider Demographics
NPI:1639390925
Name:KOCUBINSKI, CATHLEEN JILL (MPT)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:JILL
Last Name:KOCUBINSKI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MULE RD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5043
Mailing Address - Country:US
Mailing Address - Phone:732-473-1666
Mailing Address - Fax:732-473-1601
Practice Address - Street 1:9 MULE RD
Practice Address - Street 2:SUITE E-2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5043
Practice Address - Country:US
Practice Address - Phone:732-473-1666
Practice Address - Fax:732-473-1601
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01239500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123215UNEMedicare UPIN
NJ094914Medicare PIN