Provider Demographics
NPI:1023709102
Name:GUBICZA, JEFFREY ANTHONY JR
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ANTHONY
Last Name:GUBICZA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1391
Mailing Address - Country:US
Mailing Address - Phone:484-343-2930
Mailing Address - Fax:
Practice Address - Street 1:110 CARDINAL DR
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1391
Practice Address - Country:US
Practice Address - Phone:484-343-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach