Provider Demographics
NPI:1376548792
Name:RUBINSTEIN, GREG FORREST (DPM)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:FORREST
Last Name:RUBINSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4409
Mailing Address - Country:US
Mailing Address - Phone:201-836-7173
Mailing Address - Fax:201-836-0783
Practice Address - Street 1:811 GRANGE RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4409
Practice Address - Country:US
Practice Address - Phone:201-836-7173
Practice Address - Fax:201-836-0783
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00118800213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0347701Medicaid
NJT44968Medicare UPIN
NJ0347701Medicaid
NJRU440784Medicare ID - Type Unspecified