Healthcare Provider Details

I. General information

NPI: 1093722779
Provider Name (Legal Business Name): RONALD P RUBIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ROCKAWAY AVE
ROCKVILLE CENTRE NY
11570
US

IV. Provider business mailing address

40 ROCKAWAY AVE
ROCKVILLE CENTRE NY
11570
US

V. Phone/Fax

Practice location:
  • Phone: 513-763-0876
  • Fax: 718-883-6167
Mailing address:
  • Phone: 513-763-0876
  • Fax: 718-883-6167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR0289551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: