Provider Demographics
NPI:1336218668
Name:WARREN A RUBIN DPM
Entity Type:Organization
Organization Name:WARREN A RUBIN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-964-0014
Mailing Address - Street 1:1807 S BROADWAY
Mailing Address - Street 2:FL 1F
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08104-1333
Mailing Address - Country:US
Mailing Address - Phone:856-964-0014
Mailing Address - Fax:856-427-4036
Practice Address - Street 1:1807 S BROADWAY
Practice Address - Street 2:FL 1F
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104-1333
Practice Address - Country:US
Practice Address - Phone:856-964-0014
Practice Address - Fax:856-427-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD0096400332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4454060001Medicare NSC