Provider Demographics
NPI:1699881896
Name:RUBIN, KENNETH J (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:170 MORRIS AVE
Mailing Address - Street 2:D
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-8214
Mailing Address - Country:US
Mailing Address - Phone:732-870-3535
Mailing Address - Fax:732-870-8253
Practice Address - Street 1:170 MORRIS AVE
Practice Address - Street 2:D
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-8214
Practice Address - Country:US
Practice Address - Phone:732-870-3535
Practice Address - Fax:732-870-8253
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA033172002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2915405Medicaid
NJ2915405Medicaid
NJC53883Medicare UPIN