Healthcare Provider Details

I. General information

NPI: 1417732694
Provider Name (Legal Business Name): LORI J. RUBIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 COUNTY RD
CRESSKILL NJ
07626-2266
US

IV. Provider business mailing address

216 COUNTY RD
TENAFLY NJ
07670-1816
US

V. Phone/Fax

Practice location:
  • Phone: 201-224-2097
  • Fax:
Mailing address:
  • Phone: 201-638-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LORI J RUBIN
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 201-638-2735