Provider Demographics
NPI:1194747725
Name:RUBINO, GENNARO (MD)
Entity type:Individual
Prefix:DR
First Name:GENNARO
Middle Name:
Last Name:RUBINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3621
Mailing Address - Country:US
Mailing Address - Phone:973-471-4004
Mailing Address - Fax:973-471-1180
Practice Address - Street 1:1195 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3621
Practice Address - Country:US
Practice Address - Phone:973-471-4004
Practice Address - Fax:973-471-1180
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06284000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHMO BC/BSOtherBC/BS INDIVIDUAL PROVIDER
NJP490161OtherOXFORD PROVIDER NUMBER
NJ645491OtherWELL CHOICE IND PROV. #
NJ7047304Medicaid
NJDA4041OtherPALMETTO GBA - RAILROAD MEDICARE
NJ090491OtherAMERIHEALTH PROVIDER #
NJ2K1745OtherHEALTHNET IND. PROV. #
NJ1091466OtherHORIZON NJ HEALTHCARE
NJ7986025004OtherCIGNA PROVIDER NUMBER
NJP00057790OtherRAILROAD MEDICARE
NJ066918Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NJ7047304Medicaid
NJDA4041OtherPALMETTO GBA - RAILROAD MEDICARE