Healthcare Provider Details

I. General information

NPI: 1275659351
Provider Name (Legal Business Name): CRAIG S RUBENSTEIN DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 PARK AVE SUITE 1C
NEW YORK NY
10016-2507
US

IV. Provider business mailing address

258 GRANNY RD
MEDFORD NY
11763-3013
US

V. Phone/Fax

Practice location:
  • Phone: 212-213-9494
  • Fax: 212-213-9495
Mailing address:
  • Phone: 631-696-2039
  • Fax: 631-451-1733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberX005828-1
License Number StateNY

VIII. Authorized Official

Name: DR. CRAIG S RUBENSTEIN
Title or Position: OWNER
Credential: DC
Phone: 212-213-9494