Provider Demographics
NPI:1770680498
Name:HUBERT, PAUL J (CH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:HUBERT
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 FIRE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3909
Mailing Address - Country:US
Mailing Address - Phone:631-669-0956
Mailing Address - Fax:631-669-0967
Practice Address - Street 1:155 FIRE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3909
Practice Address - Country:US
Practice Address - Phone:631-669-0956
Practice Address - Fax:631-669-0967
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0053521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT86798Medicare UPIN
NYX35851Medicare PIN