1235121112 NPI number — CHERYL J RUBIN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235121112 NPI number — CHERYL J RUBIN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RUBIN

Provider First Name:

CHERYL

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1235121112

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/30/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

507 AIRPORT EXECUTIVE PARK

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

NANUET

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

10954-5238

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

845-262-5313

Provider Business Mailing Address Fax Number:

845-262-5330

Provider First Line Business Practice Location Address:

327 ROUTE 59

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

AIRMONT

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

10952

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

845-356-2900

Provider Business Practice Location Address Fax Number:

845-356-7797

Provider Enumeration Date:

08/17/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207X00000X , with the licence number:  160306 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 200021081 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 570F23 . This is a "EMPIRE BCBS (AIRMONT)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 603433 . This is a "MVP (AIRMONT/STONY POINT)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0038267 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0455138 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 570F22 . This is a "EMPIRE BCBS (MONROE)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 01077361 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 0D5327 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 391638 . This is a "MVP (MONROE)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 4667162 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 570F21 . This is a "EMPIRE BCBS (MONROE)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".