Provider Demographics
NPI:1730674243
Name:RUBIN, SIMON (HAD)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5704
Mailing Address - Country:US
Mailing Address - Phone:201-342-1080
Mailing Address - Fax:201-342-3464
Practice Address - Street 1:255 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5704
Practice Address - Country:US
Practice Address - Phone:201-342-1080
Practice Address - Fax:201-342-3464
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00143900237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist