=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194727412
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EYTAN RUBINSTIEN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2005
-----------------------------------------------------
Last Update Date | 11/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 114 WOODLAND ST INFECTIOUS
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06105-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-714-4903
-----------------------------------------------------
Fax | 860-714-8099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 ASYLUM AVE STE 2109A
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06105-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-714-6581
-----------------------------------------------------
Fax | 860-714-8311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | 024700
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------