Provider Demographics
NPI:1740559806
Name:KUBISSA, NOAH L (PT)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:L
Last Name:KUBISSA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FAIRMOUNT AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5494
Mailing Address - Country:US
Mailing Address - Phone:410-927-8768
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:535 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4934
Practice Address - Country:US
Practice Address - Phone:201-541-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01402400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist