Provider Demographics
NPI:1811397862
Name:RUBILOTTA, BRIANA MARIE (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:MARIE
Last Name:RUBILOTTA
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 ROUTE 1 N
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2652
Mailing Address - Country:US
Mailing Address - Phone:732-726-0011
Mailing Address - Fax:
Practice Address - Street 1:740 ROUTE 1 N
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2652
Practice Address - Country:US
Practice Address - Phone:732-726-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2MP00344900363A00000X
NY017749-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant