=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679688972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEUROLOGY CONSULTANTS OF BURLINGTON COUNTY, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 693 MAIN ST BUILDING D
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08048-5043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-261-7600
-----------------------------------------------------
Fax | 609-265-8205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 159
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08048-0159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-261-7600
-----------------------------------------------------
Fax | 609-265-8205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MITCHELL JAY RUBIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 609-261-7600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------