Provider Demographics
NPI:1801939723
Name:RUBBANI, MARIAM S (MD)
Entity type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:S
Last Name:RUBBANI
Suffix:
Gender:F
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:PO BOX 24008
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-0701
Mailing Address - Country:US
Mailing Address - Phone:973-483-1500
Mailing Address - Fax:973-483-4577
Practice Address - Street 1:550 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1386
Practice Address - Country:US
Practice Address - Phone:973-483-1500
Practice Address - Fax:973-483-4577
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07566500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075496U7ZMedicare ID - Type Unspecified
NJH99274Medicare UPIN