Provider Demographics
NPI:1568541027
Name:RUBINO, BARRY P (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:P
Last Name:RUBINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MORRIS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6660
Mailing Address - Country:US
Mailing Address - Phone:732-229-9417
Mailing Address - Fax:732-229-0151
Practice Address - Street 1:170 MORRIS AVE STE C
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6660
Practice Address - Country:US
Practice Address - Phone:732-229-9417
Practice Address - Fax:732-229-0151
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04682700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1364707OtherTRICARE
NJ17L831OtherEMPIRE BLUE SHIELD WELL C
NJ5094900Medicaid
NJ17L831OtherEMPIRE BLUE SHIELD WELL C
E22097Medicare UPIN