Healthcare Provider Details
I. General information
NPI: 1124663612
Provider Name (Legal Business Name): RUBI THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/08/2019
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
900 EASTON AVE SUITE 26 PMB 1013
SOMERSET NJ
08873
US
IV. Provider business mailing address
900 EASTON AVE SUITE 26 PMB 1013
SOMERSET NJ
08873
US
V. Phone/Fax
- Phone: 732-822-8487
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 235Z00000X |
| Taxonomy | Speech-Language Pathologist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MARK
SAX
Title or Position: OWNER
Credential:
Phone: 732-822-8487