Healthcare Provider Details

I. General information

NPI: 1437329273
Provider Name (Legal Business Name): GENNADY RUBINSTEIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 LAUREL CANYON BLVD STE F
STUDIO CITY CA
91604-3711
US

IV. Provider business mailing address

3959 LAUREL CANYON BLVD STE F
STUDIO CITY CA
91604-3711
US

V. Phone/Fax

Practice location:
  • Phone: 818-505-9300
  • Fax:
Mailing address:
  • Phone: 818-505-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: GENNADY RUBINSTEIN
Title or Position: OWNER
Credential: MD
Phone: 818-505-9300