Provider Demographics
NPI:1598941452
Name:ANITA A. KUBAL, M.D., P.A.
Entity type:Organization
Organization Name:ANITA A. KUBAL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-583-0100
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA039589002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1188402Medicaid
NJ0007333537Medicare PIN
NJD07013Medicare UPIN