Healthcare Provider Details

I. General information

NPI: 1538253794
Provider Name (Legal Business Name): BRUCE EDWARD RUBENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/20/2022
Certification Date: 06/15/2022
Deactivation Date: 05/27/2011
Reactivation Date: 08/04/2014

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

777 BRICKELL AVE STE 50094277
MIAMI FL
33131-2809
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-4450
  • Fax: 551-996-5729
Mailing address:
  • Phone: 929-500-3032
  • Fax: 929-600-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA09951800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number187377
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier104336500
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: