Healthcare Provider Details

I. General information

NPI: 1568533941
Provider Name (Legal Business Name): ROBERT J RUBEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHAM 3415 BAINBRIDGE AVE, 5TH FLOOR
BRONX NY
10467
US

IV. Provider business mailing address

1025 5TH AVE APT. 12C
NEW YORK NY
10028-0134
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2484
  • Fax:
Mailing address:
  • Phone: 718-920-2484
  • Fax: 718-944-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number092667
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: