Provider Demographics
NPI:1952381329
Name:KUBAL, ANITA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:A
Last Name:KUBAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 ROUTE 34
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3473
Mailing Address - Country:US
Mailing Address - Phone:732-583-0100
Mailing Address - Fax:732-583-0608
Practice Address - Street 1:1000 ROUTE 34
Practice Address - Street 2:SUITE 100
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3473
Practice Address - Country:US
Practice Address - Phone:732-583-0100
Practice Address - Fax:732-583-0608
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA39589208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1188402Medicaid
NJ1188402Medicaid