1942244520 NPI number — PATRICIA J RUBIN M.D

Table of content: PATRICIA J RUBIN M.D (NPI 1942244520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942244520 NPI number — PATRICIA J RUBIN M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBIN
Provider First Name:
PATRICIA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1942244520
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 6TH STREET S.W.
Provider Second Line Business Mailing Address:
SUITE A2-710
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-454-8076
Provider Business Mailing Address Fax Number:
330-454-3927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 6TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44710-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-454-8076
Provider Business Practice Location Address Fax Number:
330-454-3927
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  2237 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 35-05-8796-R , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0240411 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1942244520 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".




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