Provider Demographics
NPI:1164665998
Name:SHRIVER, AMY RUBIN (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RUBIN
Last Name:SHRIVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 ALEXANDER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6345
Mailing Address - Country:US
Mailing Address - Phone:609-924-1422
Mailing Address - Fax:
Practice Address - Street 1:731 ALEXANDER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6345
Practice Address - Country:US
Practice Address - Phone:609-924-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09641300207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology