Provider Demographics
NPI:1669834164
Name:GEORGE-VAZE, JUBY (RN, CCM)
Entity Type:Individual
Prefix:MRS
First Name:JUBY
Middle Name:
Last Name:GEORGE-VAZE
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:MS
Other - First Name:JUBY
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CCM
Mailing Address - Street 1:67 CLAREMONT AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4824
Mailing Address - Country:US
Mailing Address - Phone:914-420-2385
Mailing Address - Fax:
Practice Address - Street 1:67 CLAREMONT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4824
Practice Address - Country:US
Practice Address - Phone:914-420-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12031300163W00000X, 163WC0400X, 171M00000X
247000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information