Provider Demographics
NPI:1962683391
Name:MARILYN A. KUBICHEK, MD, LLC
Entity Type:Organization
Organization Name:MARILYN A. KUBICHEK, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUBICHEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-377-7822
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-0564
Mailing Address - Country:US
Mailing Address - Phone:973-377-7822
Mailing Address - Fax:973-377-7821
Practice Address - Street 1:256 COLUMBIA TPKE
Practice Address - Street 2:SUITE 109
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1209
Practice Address - Country:US
Practice Address - Phone:973-377-7822
Practice Address - Fax:973-377-7821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA060670002084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty