Healthcare Provider Details

I. General information

NPI: 1730267196
Provider Name (Legal Business Name): MITCHELL H. RUBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 ATLANTIC AVE
BROOKLYN NY
11217-2619
US

IV. Provider business mailing address

3 WASHINGTON SQUARE VLG APT 14B
NEW YORK NY
10012-1808
US

V. Phone/Fax

Practice location:
  • Phone: 718-875-1167
  • Fax:
Mailing address:
  • Phone: 212-473-7065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number140643
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: