=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396923389
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELYSE RUBENSTEIN MD A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2008
-----------------------------------------------------
Last Update Date | 02/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1328 16TH ST
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-256-2425
-----------------------------------------------------
Fax | 310-395-3218
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1328 16TH ST
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-1804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-256-2425
-----------------------------------------------------
Fax | 310-395-3218
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ELYSE RUBENSTEIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-256-2425
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------