1285633016 NPI number — RENE R RUBIN MD

Table of content: RENE R RUBIN MD (NPI 1285633016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285633016 NPI number — RENE R RUBIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBIN
Provider First Name:
RENE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1285633016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 EXPEDITION TRL STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GETTYSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17325-8599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-334-4033
Provider Business Mailing Address Fax Number:
717-334-5599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 N BROAD ST
Provider Second Line Business Practice Location Address:
6TH FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-561-0809
Provider Business Practice Location Address Fax Number:
215-561-0828
Provider Enumeration Date:
07/14/2005

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: 207RH0003X , with the licence number:  M0031135E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001004390-0016 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001004390-0019 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001004390-0011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001004390-0018 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001004390-0022 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001004390-0020 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001004390-0017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001004390-0021 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01947477 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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