Provider Demographics
NPI:1972540607
Name:RUBENSTEIN, MELINDA ANN (MSPT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANN
Last Name:RUBENSTEIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 STATE ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1445
Mailing Address - Country:US
Mailing Address - Phone:732-297-0032
Mailing Address - Fax:732-297-0558
Practice Address - Street 1:3228 U.S. HIGHWAY ROUTE T.27
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824
Practice Address - Country:US
Practice Address - Phone:732-297-0032
Practice Address - Fax:732-297-0558
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00864600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ057575QKJMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJ057568Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER