1295858942 NPI number — DR. FREDERICK LEON RUBEN M.D.

Table of content: DR. FREDERICK LEON RUBEN M.D. (NPI 1295858942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295858942 NPI number — DR. FREDERICK LEON RUBEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBEN
Provider First Name:
FREDERICK
Provider Middle Name:
LEON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUBEN
Provider Other First Name:
FREDERICK
Provider Other Middle Name:
LEON
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1295858942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 DISCOVERY DR
Provider Second Line Business Mailing Address:
BOX 187
Provider Business Mailing Address City Name:
SWIFTWATER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18370-9100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-839-5633
Provider Business Mailing Address Fax Number:
570-839-2038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 DISCOVERY DR
Provider Second Line Business Practice Location Address:
BOX 187
Provider Business Practice Location Address City Name:
SWIFTWATER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18370-9100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-839-5633
Provider Business Practice Location Address Fax Number:
570-839-2038
Provider Enumeration Date:
04/09/2007

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: 207RS0012X , with the licence number:  MD013921E , 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: MD013921E . This is a "PA LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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