Healthcare Provider Details

I. General information

NPI: 1801011747
Provider Name (Legal Business Name): HAROLD RUBIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W 90TH ST 165 WEST 91 STREET
NEW YORK NY
10024-1109
US

IV. Provider business mailing address

255 W 90TH ST
NEW YORK NY
10024-1109
US

V. Phone/Fax

Practice location:
  • Phone: 212-362-0692
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3477
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY846-PR
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: