Healthcare Provider Details

I. General information

NPI: 1477536654
Provider Name (Legal Business Name): RAN Y RUBINSTEIN M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 STONY BROOK CT
NEWBURGH NY
12550-6520
US

IV. Provider business mailing address

200 STONY BROOK CT
NEWBURGH NY
12550-6520
US

V. Phone/Fax

Practice location:
  • Phone: 845-562-6673
  • Fax: 845-839-2722
Mailing address:
  • Phone: 845-562-6673
  • Fax: 845-839-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number213058
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: