Basic Information
| Provider Information | |||||||||
| NPI: | 1326240557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUBENZIK | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | KEVIN | ||||||||
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| Credential: | M.D. PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 393 E WALNUT STREET | ||||||||
| Address2: | PHR GROUP PROVIDER ENROLLMENT UNIT 3RD FLOOR | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911880001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776080044 | ||||||||
| FaxNumber: | 8775140903 | ||||||||
| Practice Location | |||||||||
| Address1: | 233 S 10TH ST | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155035785 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 10/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0101X | A114347 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery |
No ID Information.