Provider Demographics
NPI:1962140863
Name:LUBIN-AUBOURG, REGINE E (RDN, CDN)
Entity type:Individual
Prefix:MRS
First Name:REGINE
Middle Name:E
Last Name:LUBIN-AUBOURG
Suffix:
Gender:F
Credentials:RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155-20 89TH STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2406
Mailing Address - Country:US
Mailing Address - Phone:917-325-8169
Mailing Address - Fax:
Practice Address - Street 1:155-20 89TH STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2406
Practice Address - Country:US
Practice Address - Phone:917-325-8169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0891896133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty