Healthcare Provider Details

I. General information

NPI: 1437149291
Provider Name (Legal Business Name): MITCHELL RUBIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 BOSTON POST RD
LARCHMONT NY
10538-3500
US

IV. Provider business mailing address

2365 BOSTON POST RD
LARCHMONT NY
10538-3500
US

V. Phone/Fax

Practice location:
  • Phone: 914-834-0111
  • Fax: 914-834-0259
Mailing address:
  • Phone: 914-834-0111
  • Fax: 914-834-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number04132
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number04132
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number04132
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number04132
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number04132
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: