MEDICARE: RUBICONMD NEW JERSEY PHYSICIANS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
3	207L00000X	Anesthesiology Physician
4	207N00000X	Dermatology Physician
5	207RC0000X	Cardiovascular Disease Physician
6	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
7	207RG0100X	Gastroenterology Physician
8	207RG0300X	Geriatric Medicine (Internal Medicine) Physician
9	207RH0003X	Hematology & Oncology Physician
10	207RI0200X	Infectious Disease Physician
11	207RN0300X	Nephrology Physician
12	207RS0012X	Sleep Medicine (Internal Medicine) Physician
13	207V00000X	Obstetrics & Gynecology Physician
14	208000000X	Pediatrics Physician
15	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1922604248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUBICONMD NEW JERSEY PHYSICIANS, P.C.

Provider Business Mailing Address
First Line	:	4953 MCGILL WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 S DALE MABRY HWY UNIT 4105
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-1434
Country	:	US
Telephone Number	:	860-262-4489
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERIC ADDO
Credential	:	MD
Telephone Number	:	860-262-4489

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	12/10/2020

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