Provider Demographics
NPI:1386909398
Name:NIELUBOWICZ, ALYSSA RAE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:RAE
Last Name:NIELUBOWICZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 KINGS HWY S
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2500
Mailing Address - Country:US
Mailing Address - Phone:856-429-4600
Mailing Address - Fax:
Practice Address - Street 1:401 KINGS HWY S
Practice Address - Street 2:SUITE 2A
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2500
Practice Address - Country:US
Practice Address - Phone:856-429-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0391741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice