Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 44SL06591700 | NJ |
NPI | 1003584897 |
---|---|
Provider Name | Mr. Samuel H Luba |
First Address | Old Tappan, NJ 07675-6863 |
Second Address | Jersey City, NJ 07306-1388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2021 |
Last Update Date | 06/09/2021 |