1275722753 NPI number — RUB PEDIATRICS MD PA

Table of content: (NPI 1275722753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275722753 NPI number — RUB PEDIATRICS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUB PEDIATRICS MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1275722753
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21110 BISCAYNE BLVD
Provider Second Line Business Mailing Address:
SUITE 308
Provider Business Mailing Address City Name:
AVENTURA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33180-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-932-1007
Provider Business Mailing Address Fax Number:
305-696-6225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1190 NW 95TH ST
Provider Second Line Business Practice Location Address:
SUITE 409
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33150-2063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-696-9490
Provider Business Practice Location Address Fax Number:
305-696-6225
Provider Enumeration Date:
10/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEUSCHATZ
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
305-932-1007

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME55002 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME54702 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000101139 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00821 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01398168 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1306802186 . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 01398181 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000100573 . This is a "HUMANA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 051960000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051961801 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1376509638 . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 01778539 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051963400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 024098500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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