Provider Demographics
NPI:1548259070
Name:RUBIN, JONATHAN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SCOTT
Last Name:RUBIN
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 1:6535 NW 95TH LN
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2313
Mailing Address - Country:US
Mailing Address - Phone:954-979-3292
Mailing Address - Fax:954-970-4308
Practice Address - Street 1:2825 N STATE ROAD 7
Practice Address - Street 2:SUITE 205
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5737
Practice Address - Country:US
Practice Address - Phone:954-979-3292
Practice Address - Fax:954-970-4308
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59741208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR1561845OtherDEA
E59663Medicare UPIN
12851Medicare ID - Type UnspecifiedMEDICARE