Healthcare Provider Details

I. General information

NPI: 1619979416
Provider Name (Legal Business Name): DANIEL YORK REUBEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/03/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 POST RD STE 204
FAIRFIELD CT
06824-6232
US

IV. Provider business mailing address

1290 SILAS DEANE HIGHWAY HHC - CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-4545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number37540
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number39627
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: