Provider Demographics
NPI:1124292057
Name:KUBICK, CHRISTIAN JOHN
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JOHN
Last Name:KUBICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1326
Mailing Address - Country:US
Mailing Address - Phone:973-467-1690
Mailing Address - Fax:973-258-9075
Practice Address - Street 1:393 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1326
Practice Address - Country:US
Practice Address - Phone:973-467-1690
Practice Address - Fax:973-258-9075
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD3159156FX1101X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant