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NPI Code Detail

MEDICARE: GERRY RUBIN MD

MEDICARE: GERRY RUBIN MD
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
1207RH0003XHematology & Oncology Physician177178NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982677761
Entity Type Code : Individual
Provider Name (Legal Business Name) : GERRY RUBIN MD
Provider Business Mailing Address
First Line : 1500 ROUTE 112 BLDG 4
Second Line : SUITE101
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-3456
Country : US
Telephone Number : 631-574-8354
Fax Number : 631-509-6559
Provider Business Practice Location Address
First Line : 180 E MAIN ST
Second Line :
City : BAY SHORE
State : NY
Zip : 11706-8427
Country : US
Telephone Number : 631-751-3000
Fax Number : 631-675-2001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2006
Last Update Date : 08/06/2019

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