Healthcare Provider Details

I. General information

NPI: 1245369297
Provider Name (Legal Business Name): ELYSE S. RUBENSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 LADDERBACK LN.
DEVON PA
19333
US

IV. Provider business mailing address

185 LADDERBACK LN.
DEVON PA
19333
US

V. Phone/Fax

Practice location:
  • Phone: 610-254-8515
  • Fax: 610-341-0584
Mailing address:
  • Phone: 610-254-8515
  • Fax: 610-341-0584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberMD034864E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD034864-E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: