Provider Demographics
NPI:1902950546
Name:BUBIS, EUGENE (ND, LDN)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:BUBIS
Suffix:
Gender:M
Credentials:ND, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 WALNUT ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1163 WALNUT ST
Practice Address - Street 2:SUITE 12
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1265
Practice Address - Country:US
Practice Address - Phone:617-965-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1911133N00000X, 133V00000X
OR1019175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA23515OtherHARVARD PILGRIM
MALD0082OtherBCBSMA
MALD0082OtherBCBSMA