=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265894943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NY DIABETES & ENDOCRINOLOGY CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2016
-----------------------------------------------------
Last Update Date | 05/25/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6271 WOODHAVEN BLVD
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-2832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-335-9000
-----------------------------------------------------
Fax | 718-335-9001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6271 WOODHAVEN BLVD
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-2832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-335-9000
-----------------------------------------------------
Fax | 718-335-9001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RAKHIL RUBINOVA
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 718-335-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------