Provider Demographics
NPI:1124078381
Name:SHAHIDI, RUBINA A (MD)
Entity type:Individual
Prefix:
First Name:RUBINA
Middle Name:A
Last Name:SHAHIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5201 DEBORAH DR
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4805
Mailing Address - Country:US
Mailing Address - Phone:630-808-4909
Mailing Address - Fax:630-420-2727
Practice Address - Street 1:115 CHRISTOPHER COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5526
Practice Address - Country:US
Practice Address - Phone:201-451-6300
Practice Address - Fax:201-451-8300
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036107398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107398Medicaid
H78684Medicare UPIN
ILL99870Medicare ID - Type UnspecifiedFEE SCHEDULE LOCALITY 15
IL036107398Medicaid