Basic Information
| Provider Information | |||||||||
| NPI: | 1760464929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBIN | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | HERR | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HERR | ||||||||
| OtherFirstName: | MELISSA | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 746 FITZWATER ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191472815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 208 WHITE HORSE PIKE | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | BARRINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080071322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565461535 | ||||||||
| FaxNumber: | 8565466565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 41YA00058100 | NJ | X | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 25MG00091400 | NJ | X | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.