Healthcare Provider Details

I. General information

NPI: 1770816688
Provider Name (Legal Business Name): GULNARA RUBINSHTEYN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 BLACK RIVER BLVD N
ROME NY
13440-2427
US

IV. Provider business mailing address

1801 BLACK RIVER BLVD N
ROME NY
13440-2427
US

V. Phone/Fax

Practice location:
  • Phone: 315-337-3770
  • Fax:
Mailing address:
  • Phone: 315-337-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number254749
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: