Healthcare Provider Details

I. General information

NPI: 1790715639
Provider Name (Legal Business Name): SUSAN RUBENSTEIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HILLSIDE AVE SUITE G
WILLISTON PARK NY
11596-2311
US

IV. Provider business mailing address

105 HILLSIDE AVE
WILLISTON PARK NY
11596-2311
US

V. Phone/Fax

Practice location:
  • Phone: 516-294-0910
  • Fax: 516-801-0917
Mailing address:
  • Phone: 516-353-1048
  • Fax: 516-801-0917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7099
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: