=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164040705
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW HORIZONS GASTROENTEROLOGY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2020
-----------------------------------------------------
Last Update Date | 07/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 585 STEWART AVE STE 412
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-385-5800
-----------------------------------------------------
Fax | 516-385-5770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 585 STEWART AVE STE 412
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530-4701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-385-5800
-----------------------------------------------------
Fax | 516-385-5770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEVEN D RUBIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 917-415-8420
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------