Healthcare Provider Details

I. General information

NPI: 1922042175
Provider Name (Legal Business Name): ROBERT MITCHELL RUBINOVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E CHESTNUT ST SUITE 106
ROME NY
13440-2834
US

IV. Provider business mailing address

107 E CHESTNUT ST SUITE 106
ROME NY
13440-2834
US

V. Phone/Fax

Practice location:
  • Phone: 315-338-9200
  • Fax: 315-338-9202
Mailing address:
  • Phone: 315-338-9200
  • Fax: 315-338-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: