Provider Demographics
NPI:1689665978
Name:RUBIN, ROBERTA GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:GAIL
Last Name:RUBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ROBERTA
Other - Middle Name:GAIL
Other - Last Name:DULL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1215
Mailing Address - Country:US
Mailing Address - Phone:973-429-2515
Mailing Address - Fax:973-429-2544
Practice Address - Street 1:4 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4173
Practice Address - Country:US
Practice Address - Phone:845-368-7403
Practice Address - Fax:846-369-7082
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY83996207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0326003Medicaid
NJ0326003Medicaid
D06392Medicare UPIN