Provider Demographics
NPI:1881750685
Name:RUBIN, EVAN S (DO)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:S
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:55 N. GILBERT STREET
Mailing Address - Street 2:SUITE 3102
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9848
Practice Address - Street 1:55 N. GILBERT STREET
Practice Address - Street 2:SUITE 3102
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-460-9840
Practice Address - Fax:732-460-9848
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08321200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY082SYIMedicare UPIN