Provider Demographics
NPI:1649580820
Name:KENNETH J RUBIN MD PA
Entity Type:Organization
Organization Name:KENNETH J RUBIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-870-3535
Mailing Address - Street 1:170 MORRIS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-8214
Mailing Address - Country:US
Mailing Address - Phone:732-870-3535
Mailing Address - Fax:
Practice Address - Street 1:170 MORRIS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-8214
Practice Address - Country:US
Practice Address - Phone:732-870-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03317200261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ198702Medicare PIN