Provider Demographics
NPI:1245975861
Name:CHERUBIN, MARIE JULINE (APN)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:JULINE
Last Name:CHERUBIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2414
Mailing Address - Country:US
Mailing Address - Phone:848-256-9392
Mailing Address - Fax:908-402-4846
Practice Address - Street 1:1560 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2414
Practice Address - Country:US
Practice Address - Phone:848-256-9392
Practice Address - Fax:908-402-4846
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01301900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0847208Medicaid