Provider Demographics
NPI:1912948738
Name:RUBINO, SUSAN BASRA (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BASRA
Last Name:RUBINO
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 1:85 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2449
Mailing Address - Country:US
Mailing Address - Phone:973-315-9076
Mailing Address - Fax:973-376-0357
Practice Address - Street 1:85 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2449
Practice Address - Country:US
Practice Address - Phone:973-315-9076
Practice Address - Fax:973-376-0357
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA067023207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG87171Medicare UPIN
NJ097439Medicare ID - Type Unspecified