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General NPI Number Information
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NPI Number | 1114280427
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Entity Type | Individual
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Provider Name | JASON SETH RUBIN D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 1020 E OGDEN AVE STE 214
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City | NAPERVILLE
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State | IL
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Zip | 60563-8610
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Country | US
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Telephone | 630-780-3668
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Fax | 630-839-4050
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Provider Business Mailing Address
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Address Line | 1020 E OGDEN AVE STE 214
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City | NAPERVILLE
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State | IL
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Zip | 60563-8610
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Country | US
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Telephone | 630-780-3668
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Fax | 630-839-4050
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016005582
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License Number State | IL
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