MEDICARE: KELSEY RUBIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	003081	CT
2	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1295148021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY RUBIN

Provider Business Mailing Address
First Line	:	1000 ASYLUM AVE
Second Line	:	STE 2126
City	:	HARTFORD
State	:	CT
Zip	:	06105-1718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 PINE RIDGE RD STE 19
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-2110
Country	:	US
Telephone Number	:	239-593-0663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	05/09/2019

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Directions to “ KELSEY RUBIN ” Practice Location

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