Provider Demographics
NPI:1275970907
Name:STOLL RUBIN, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:STOLL RUBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 AYCRIGG AVE
Mailing Address - Street 2:APT B
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4775
Mailing Address - Country:US
Mailing Address - Phone:973-928-1645
Mailing Address - Fax:
Practice Address - Street 1:238 AYCRIGG AVE
Practice Address - Street 2:APT B
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4775
Practice Address - Country:US
Practice Address - Phone:973-928-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00686200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist