Healthcare Provider Details

I. General information

NPI: 1275883647
Provider Name (Legal Business Name): HARVEY L. RUBEN, MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 AMITY RD SUITE 130
WOODBRIDGE CT
06525
US

IV. Provider business mailing address

270 AMITY RD SUITE 130
WOODBRIDGE CT
06525
US

V. Phone/Fax

Practice location:
  • Phone: 203-397-0064
  • Fax: 203-397-3537
Mailing address:
  • Phone: 203-397-0064
  • Fax: 203-397-3537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number002814
License Number StateCT

VIII. Authorized Official

Name: HARVEY L RUBEN
Title or Position: PRESIDENT
Credential: MD
Phone: 203-397-0064