Healthcare Provider Details

I. General information

NPI: 1043728058
Provider Name (Legal Business Name): R MITCHELL RUBINOVICH MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 N GEORGE ST
ROME NY
13440-3415
US

IV. Provider business mailing address

1109 N GEORGE ST
ROME NY
13440-3415
US

V. Phone/Fax

Practice location:
  • Phone: 315-207-4222
  • Fax: 315-533-4377
Mailing address:
  • Phone: 315-207-4222
  • Fax: 315-533-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number199009
License Number StateNY

VIII. Authorized Official

Name: MICHELE A REDMOND
Title or Position: BILLING MANAGER
Credential:
Phone: 315-207-4222