Provider Demographics
NPI:1710545959
Name:RUBIN, SIMONE GABRIELLE (DO)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:GABRIELLE
Last Name:RUBIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1451
Mailing Address - Country:US
Mailing Address - Phone:201-291-6000
Mailing Address - Fax:
Practice Address - Street 1:50 ESSEX ST STE 5
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4341
Practice Address - Country:US
Practice Address - Phone:201-843-3152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11414000207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine