Healthcare Provider Details

I. General information

NPI: 1487082731
Provider Name (Legal Business Name): KIMBERLY ANN RUBINO A.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 LANES MILL RD STE 201
LAKEWOOD NJ
08701-3894
US

IV. Provider business mailing address

1382 LANES MILL RD STE 201
LAKEWOOD NJ
08701-3894
US

V. Phone/Fax

Practice location:
  • Phone: 732-994-4242
  • Fax: 732-363-5164
Mailing address:
  • Phone: 732-994-4242
  • Fax: 732-363-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ00466400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00466400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: