1245261882 NPI number — DR. JORGE ULISES RUBI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245261882 NPI number — DR. JORGE ULISES RUBI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RUBI

Provider First Name:

JORGE

Provider Middle Name:

ULISES

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1245261882

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/16/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3421 CONCORD RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

YORK

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

17402-9001

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

717-851-7315

Provider Business Mailing Address Fax Number:

717-741-3056

Provider First Line Business Practice Location Address:

2350 FREEDOM WAY STE 150

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

YORK

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

17402-8200

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

717-851-7315

Provider Business Practice Location Address Fax Number:

717-741-3056

Provider Enumeration Date:

07/05/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  MD067674L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0077216000 . This is a "AMERIHEALTH 65 PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 039811 . This is a "JOHNS HOPKINS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 54094 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 7145869 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 001737756 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 434779 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 779864 . This is a "CAREFIRST MD BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 91734 . This is a "UNISON-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 01105502 . This is a "CAPITAL BLUE CROSS-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 268937 . This is a "MAMSI-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: P002877 . This is a "GATEWAY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1142433 . This is a "AMERIHEALTH MERCY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".