Provider Demographics
NPI:1619381514
Name:RUBIN, KRISTEN (AUD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:RUBIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:400 BALD HILL RD
Mailing Address - Street 2:SUITE 529
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1617
Mailing Address - Country:US
Mailing Address - Phone:401-595-7318
Mailing Address - Fax:
Practice Address - Street 1:400 BALD HILL RD
Practice Address - Street 2:SUITE 529
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1617
Practice Address - Country:US
Practice Address - Phone:401-595-7318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAUD00219231H00000X
NJ41YA00089700231H00000X
NJ25MG00130200237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YA00089700OtherAUDIOLOGY LICENSE STATE OF NJ