Provider Demographics
NPI:1972762730
Name:KIM, RUBY (MD)
Entity type:Individual
Prefix:DR
First Name:RUBY
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 CENTER AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4612
Mailing Address - Country:US
Mailing Address - Phone:201-242-1600
Mailing Address - Fax:201-299-2555
Practice Address - Street 1:1555 CENTER AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4612
Practice Address - Country:US
Practice Address - Phone:201-242-1600
Practice Address - Fax:201-299-2555
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244653-1208100000X
NJ25MA087959002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ150155GF6Medicare PIN