Provider Demographics
NPI:1538253794
Name:RUBENSTEIN, BRUCE EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:EDWARD
Last Name:RUBENSTEIN
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 1:777 BRICKELL AVE STE 50094277
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2809
Mailing Address - Country:US
Mailing Address - Phone:929-500-3032
Mailing Address - Fax:929-600-2570
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1915
Practice Address - Country:US
Practice Address - Phone:551-996-4450
Practice Address - Fax:551-996-5729
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-07-20
Deactivation Date:2011-05-27
Deactivation Code:
Reactivation Date:2014-08-04
Provider Licenses
StateLicense IDTaxonomies
NJ25MA099518002084P0800X
NY1873772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04615427Medicaid
NYF78036Medicare UPIN