Provider Demographics
NPI:1295162261
Name:RUB PEDIATRICS MD PA
Entity type:Organization
Organization Name:RUB PEDIATRICS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUSCHATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-932-1007
Mailing Address - Street 1:21110 BISCAYNE BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1229
Mailing Address - Country:US
Mailing Address - Phone:305-932-1007
Mailing Address - Fax:305-696-6225
Practice Address - Street 1:601 N FLAMINGO RD STE 103
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1007
Practice Address - Country:US
Practice Address - Phone:305-932-1007
Practice Address - Fax:305-696-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000100573OtherHUMANA
FL051963400Medicaid
FL01398168OtherAMERIGROUP
FL051960000Medicaid
FL051961801Medicaid
00821OtherBCBS
FL01778539OtherAMERIGROUP
FL000101139OtherHUMANA
FL01398181OtherAMERIGROUP
FL01398168OtherAMERIGROUP
FLE75837Medicare UPIN