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General NPI Number Information
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NPI Number | 1508052846
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY AND LIVER DISEASE OF THE BRONX, P.C.
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1180 MORRIS PARK AVE 3RD FLOOR
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City | BRONX
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State | NY
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Zip | 10461-1925
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Country | US
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Telephone | 718-879-6600
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Fax | 718-892-6594
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Provider Business Mailing Address
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Address Line | 1180 MORRIS PARK AVE 3RD FLOOR
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City | BRONX
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State | NY
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Zip | 10461-1925
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Country | US
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Telephone | 718-879-6600
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Fax | 718-892-6594
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK I. RUBIN
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Credential | M.D.
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Telephone | 718-879-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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