Provider Demographics
NPI:1194895649
Name:DUBETSKY, IRIS (PA)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:DUBETSKY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 BELMAR BLVD STE I-1
Mailing Address - Street 2:
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3983
Mailing Address - Country:US
Mailing Address - Phone:609-495-8644
Mailing Address - Fax:908-520-4216
Practice Address - Street 1:2510 BELMAR BLVD STE I-1
Practice Address - Street 2:
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3983
Practice Address - Country:US
Practice Address - Phone:609-495-8644
Practice Address - Fax:908-520-4216
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMP000333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ331149MAGMedicare PIN