Provider Demographics
NPI:1154967578
Name:RUBI, ROD ANTHONY BRIGOLI
Entity type:Individual
Prefix:
First Name:ROD ANTHONY
Middle Name:BRIGOLI
Last Name:RUBI
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 1:303 SAINT THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-4202
Mailing Address - Country:US
Mailing Address - Phone:609-204-3844
Mailing Address - Fax:
Practice Address - Street 1:210 S SHORE RD STE 203
Practice Address - Street 2:
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1271
Practice Address - Country:US
Practice Address - Phone:609-390-2400
Practice Address - Fax:609-390-9587
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01903800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist