Healthcare Provider Details

I. General information

NPI: 1508674821
Provider Name (Legal Business Name): MENACHEM RUBENSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 RUTLAND RD
BROOKLYN NY
11203-1703
US

IV. Provider business mailing address

587 RUTLAND RD
BROOKLYN NY
11203-1703
US

V. Phone/Fax

Practice location:
  • Phone: 917-392-1285
  • Fax:
Mailing address:
  • Phone: 917-392-1285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: