Provider Demographics
NPI:1346550571
Name:RUBIN, MELISSA THERESA (APN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:THERESA
Last Name:RUBIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 NEWMAN SPRINGS RD
Mailing Address - Street 2:BUILDING 1, 4TH FLOOR, SUITE 143
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5688
Mailing Address - Country:US
Mailing Address - Phone:732-832-7817
Mailing Address - Fax:201-632-6446
Practice Address - Street 1:331 NEWMAN SPRINGS RD
Practice Address - Street 2:BUILDING 1, 4TH FLOOR, SUITE 143
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5688
Practice Address - Country:US
Practice Address - Phone:732-832-7817
Practice Address - Fax:609-336-7897
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11249000363LA2200X, 363LC0200X, 363LP2300X
NJ26NJ00302600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ207552C6CMedicare PIN
NJ212663BB4Medicare PIN