Provider Demographics
NPI:1457337826
Name:RUBIN, MITCHELL JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:JAY
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 FAU BOULEVARD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5811
Mailing Address - Country:US
Mailing Address - Phone:305-243-3100
Mailing Address - Fax:561-393-7312
Practice Address - Street 1:3848 FAU BOULEVARD
Practice Address - Street 2:SUITE 305
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5811
Practice Address - Country:US
Practice Address - Phone:305-243-3100
Practice Address - Fax:561-393-7312
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0456782084N0400X
NJ25MA045678002084N0400X
FLME976992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2276500Medicaid
NJ2276500Medicaid
077356 SK3Medicare PIN
077356 SK3Medicare PIN