Healthcare Provider Details

I. General information

NPI: 1174512495
Provider Name (Legal Business Name): GLENN M RUBENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E CHESTER PIKE
RIDLEY PARK PA
19078-2284
US

IV. Provider business mailing address

PO BOX 650782
DALLAS TX
75265-0782
US

V. Phone/Fax

Practice location:
  • Phone: 215-442-5085
  • Fax: 877-329-2370
Mailing address:
  • Phone: 302-733-0806
  • Fax: 302-733-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD046020L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA08705300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME113047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: