Healthcare Provider Details

I. General information

NPI: 1104927078
Provider Name (Legal Business Name): ADAM IAN RUBIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E 41ST ST FL 25
NEW YORK NY
10017-6739
US

IV. Provider business mailing address

222 E 41ST ST FL 25
NEW YORK NY
10017-6739
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7250
  • Fax: 929-455-9512
Mailing address:
  • Phone: 212-263-7250
  • Fax: 929-455-9512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD426361
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number226561
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD426361
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number226561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: