Healthcare Provider Details

I. General information

NPI: 1760543193
Provider Name (Legal Business Name): LEONARD A RUBINSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 SIESTA DRIVE
SARASOTA FL
34239
US

IV. Provider business mailing address

1805 SIESTA DRIVE
SARASOTA FL
34239
US

V. Phone/Fax

Practice location:
  • Phone: 941-957-3890
  • Fax: 941-955-1366
Mailing address:
  • Phone: 941-957-3890
  • Fax: 941-955-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberME37720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: