1437149291 NPI number — MR. MITCHELL RUBIN DPM

Table of content: MR. MITCHELL RUBIN DPM (NPI 1437149291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437149291 NPI number — MR. MITCHELL RUBIN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBIN
Provider First Name:
MITCHELL
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437149291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2365 BOSTON POST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARCHMONT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10538-3500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-834-0111
Provider Business Mailing Address Fax Number:
914-834-0259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2365 BOSTON POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARCHMONT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10538-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-834-0111
Provider Business Practice Location Address Fax Number:
914-834-0259
Provider Enumeration Date:
10/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  04132 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213EP1101X , with the licence number: 04132 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ER0200X , with the licence number: 04132 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0000X , with the licence number: 04132 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0131X , with the licence number: 04132 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0098513-2 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 058-2761 . This is a "AETNA GOLDEN MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RS048 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 37050 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1C1595 . This is a "PHS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0048654 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P4359 . This is a "BLUE CHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 582-761 . This is a "US HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0582761 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".