Healthcare Provider Details

I. General information

NPI: 1427074756
Provider Name (Legal Business Name): DIMETRIS ROUBIS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOLLOW LN SUITE 110-NORTH SHORE ALLERGY & ASTHMA INSTITUTE
NEW HYDE PARK NY
11042-1215
US

IV. Provider business mailing address

1 HOLLOW LN SUITE 110-NORTH SHORE ALLERGY & ASTHMA INSTITUTE
NEW HYDE PARK NY
11042-1215
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-6666
  • Fax: 516-869-1123
Mailing address:
  • Phone: 516-365-6666
  • Fax: 516-869-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: