MEDICARE: ELYSE RUBENSTEIN MD, A PROFESSIONAL CORPORATION

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1962716373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELYSE RUBENSTEIN MD, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2980 N BEVERLY GLEN CIR
Second Line	:	STE 301
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1726
Country	:	US
Telephone Number	:	310-474-9809
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 16TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1804
Country	:	US
Telephone Number	:	310-256-2425
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELYSE RUBENSTEIN
Credential	:	MD
Telephone Number	:	310-256-2425

Provider Enumeration Date	:	07/28/2010
Last Update Date	:	03/01/2011

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