Healthcare Provider Details

I. General information

NPI: 1881692200
Provider Name (Legal Business Name): EUGENE RUBACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2005
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 PLANDOME ROAD
MANHASSET NY
11030-2331
US

IV. Provider business mailing address

POB 528
PORT WASHINGTON NY
11050-0528
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-5262
  • Fax: 516-627-0641
Mailing address:
  • Phone: 516-629-2484
  • Fax: 516-629-2452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number231307
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number231307
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: