1275803892 NPI number — RUBIN BRECHER MD LLC

Table of content: (NPI 1275803892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275803892 NPI number — RUBIN BRECHER MD LLC

Organization/Personal Information

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

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:
1275803892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 MEADOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11559-1828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-851-1186
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
736 OCEAN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-851-7786
Provider Business Practice Location Address Fax Number:
718-853-8239
Provider Enumeration Date:
01/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BRECHER
Authorized Official First Name:
RUBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-851-1186

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  165798 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 172663 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01168941 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28967P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4265264 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 29160101 . This is a "HEALTHPLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 165798S . This is a "HEALTHCARE PARTNERS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: KS265 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: IC3114 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 16075 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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