| Doctor Name: | DR. NICOLE DAWN RUBACKIN-HAYWARD |
| NPI Number: | 1316176068 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPM |
| License Number: | 25MD00298400 |
| Business Practice Address: | 159 Marlboro Rd Glen Rock, NJ - 074521902 |
| Business Phone Number: | 2018574467 |
| Business Fax Number: | |
| Mailing Address: | 159 Marlboro Rd, GLEN ROCK |
| State: | NJ |
| Postal Code: | 074521902 |
| Phone Number: | 2018574467 |
| Fax Number: | |
| NPI Enumeration Date: | 07/02/2009 |
| NPI Last Update Date: | 07/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 25MD00298400 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |