Provider Demographics
NPI:1063967917
Name:RUBIN, EVAN M
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:M
Last Name:RUBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 DUNCAN DR
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1614
Mailing Address - Country:US
Mailing Address - Phone:215-880-5607
Mailing Address - Fax:
Practice Address - Street 1:1220 DUNCAN DR
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1614
Practice Address - Country:US
Practice Address - Phone:215-880-5607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies