Provider Demographics
NPI:1861150054
Name:RUBIN, ERIC (EDS)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 PLEASANT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-4460
Mailing Address - Country:US
Mailing Address - Phone:267-872-9133
Mailing Address - Fax:
Practice Address - Street 1:2004 PLEASANT VALLEY DR
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-4460
Practice Address - Country:US
Practice Address - Phone:267-872-9133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool