Provider Demographics
NPI:1477880193
Name:MICHAEL RUBCICH FOUR GATES ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:MICHAEL RUBCICH FOUR GATES ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBCICH
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:856-228-1330
Mailing Address - Street 1:805 S BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2813
Mailing Address - Country:US
Mailing Address - Phone:856-228-1330
Mailing Address - Fax:856-228-4322
Practice Address - Street 1:805 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2813
Practice Address - Country:US
Practice Address - Phone:856-228-1330
Practice Address - Fax:856-228-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00597500261QM2500X
NJ25MZ00041700261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty