Healthcare Provider Details

I. General information

NPI: 1609919984
Provider Name (Legal Business Name): MRS. BONNIE LYNN RUBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 2 MONTAUK HIGHWAY TENDER AGE PT INC
OAKDALE NY
11769
US

IV. Provider business mailing address

562 CHESTER ROAD
SAYVILLE NY
11782
US

V. Phone/Fax

Practice location:
  • Phone: 631-218-1545
  • Fax: 631-218-2650
Mailing address:
  • Phone: 631-750-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0021831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: