1063487742 NPI number — JOYCE D RUBIN MD

Table of content: JOYCE D RUBIN MD (NPI 1063487742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063487742 NPI number — JOYCE D RUBIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUBIN
Provider First Name:
JOYCE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1063487742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 EXPRESSWAY DR N
Provider Second Line Business Mailing Address:
SUITE 116
Provider Business Mailing Address City Name:
ISLANDIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11749-5301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-292-6747
Provider Business Mailing Address Fax Number:
631-292-6767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 EXPRESSWAY DR N
Provider Second Line Business Practice Location Address:
SUITE 116
Provider Business Practice Location Address City Name:
ISLANDIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11749-5301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-292-6747
Provider Business Practice Location Address Fax Number:
631-292-6767
Provider Enumeration Date:
02/17/2006

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: 174400000X , with the licence number:  237546-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VG0400X , with the licence number: 237546-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0000X , with the licence number: 237546-1 , 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: 237546 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0778181 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00468552 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02711315 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P3702216 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0104478 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2577494 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4256082 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 817C71 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5C5859 . This is a "HEALTHNET/PHS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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