Healthcare Provider Details

I. General information

NPI: 1619397825
Provider Name (Legal Business Name): SEBASTIAN RUBINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2014
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEAVIEW AVE STE 201
STATEN ISLAND NY
10305-3400
US

IV. Provider business mailing address

501 SEAVIEW AVE STE 201
STATEN ISLAND NY
10305-3400
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-4940
  • Fax:
Mailing address:
  • Phone: 718-226-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number315351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: