Basic Information
| Provider Information | |||||||||
| NPI: | 1528234432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUBERU | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | SARANA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12265 TOWNSEND RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191541201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158561010 | ||||||||
| FaxNumber: | 2156983730 | ||||||||
| Practice Location | |||||||||
| Address1: | 727 WELSH ROAD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | HUNTINGTON VALLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159394251 | ||||||||
| FaxNumber: | 8553853043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2008 | ||||||||
| LastUpdateDate: | 01/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD434267 | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.