Provider Demographics
NPI:1740565308
Name:BEEBE, MARIA VICTORIA PERTUBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA VICTORIA
Middle Name:PERTUBAL
Last Name:BEEBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA VICTORIA
Other - Middle Name:
Other - Last Name:PERTUBAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:613 WASHINGTON BLVD # 1058
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2900
Mailing Address - Country:US
Mailing Address - Phone:646-874-4758
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6504
Practice Address - Country:US
Practice Address - Phone:646-884-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09505800208000000X
NY288767208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0425516Medicaid
NY05860577Medicaid