Provider Demographics
NPI:1033412382
Name:RUBI, RODERICK JAMES
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:JAMES
Last Name:RUBI
Suffix:
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 1:132 PINEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1446
Mailing Address - Country:US
Mailing Address - Phone:845-623-7326
Mailing Address - Fax:
Practice Address - Street 1:132 PINEVIEW AVE
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-1446
Practice Address - Country:US
Practice Address - Phone:845-623-7326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY628179163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse