Provider Demographics
NPI:1528126711
Name:HUBSCHMANN, OTAKAR R (MD FACS)
Entity type:Individual
Prefix:
First Name:OTAKAR
Middle Name:R
Last Name:HUBSCHMANN
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OLD SHORT HILLS RD STE 409
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1023
Mailing Address - Country:US
Mailing Address - Phone:973-322-6732
Mailing Address - Fax:973-322-6545
Practice Address - Street 1:101 OLD SHORT HILLS RD STE 409
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1023
Practice Address - Country:US
Practice Address - Phone:973-322-6732
Practice Address - Fax:973-322-6545
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0315500207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00617067OtherRAILROAD MEDICARE PTAN
D96649Medicare UPIN
NJP00617067OtherRAILROAD MEDICARE PTAN