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General NPI Number Information
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NPI Number | 1558553313
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Entity Type | Individual
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Provider Name | BRIAN G DE RUBERTIS MD
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Gender | Male
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 525 E 68TH ST # F835-A
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City | NEW YORK
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State | NY
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Zip | 10065-4870
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Country | US
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Telephone | 646-962-8450
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Fax | 646-962-0323
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Provider Business Mailing Address
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Address Line | 525 E 68TH ST # 197
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City | NEW YORK
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State | NY
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Zip | 10065-4870
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Country | US
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Telephone | 646-962-8450
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Fax | 646-962-0323
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 21807301
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License Number State | NY
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