Healthcare Provider Details

I. General information

NPI: 1679441505
Provider Name (Legal Business Name): DAWN RUBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 ARISTA DR
DIX HILLS NY
11746-4920
US

IV. Provider business mailing address

43 ARISTA DR
DIX HILLS NY
11746-4920
US

V. Phone/Fax

Practice location:
  • Phone: 631-683-4393
  • Fax: 631-683-4395
Mailing address:
  • Phone: 631-683-4393
  • Fax: 631-683-4395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number230674-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: