Provider Demographics
NPI:1881664316
Name:RUBIN, CARL S (DO)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:S
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NESHAMINY INTERPLEX
Mailing Address - Street 2:SUITE 209
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6940
Mailing Address - Country:US
Mailing Address - Phone:215-244-3070
Mailing Address - Fax:215-638-9041
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003047L2085R0202X
NJ25MB027523002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA7584OtherHEALTH NET
PA03142OS003047LOtherHEALTH PARTNERS
PA120724OtherPHCS
PA0046756000OtherIBC
PA20045222OtherAMERIHEALTH MERCY
PA0046756000OtherKEYSTONE HEALTH PLAN EAST
NJ0108537Medicaid
PA000641258-0004Medicaid
PA00641258OtherAMERICHOICE OF PA
PA051705OtherHIGHMARK BLUE SHIELD
PA1030295OtherKEYSTONE MERCY
PAE02336Medicare UPIN
PA051705OtherHIGHMARK BLUE SHIELD
NJ0108537Medicaid