=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588813190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHERMAN RUBIN, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2008
-----------------------------------------------------
Last Update Date | 09/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9207 ROOSEVELT AVENUE
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-7941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-396-3241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9207 ROOSEVELT AVENUE
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-7941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-396-3241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | NANCY MARCANTONIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-665-9531
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------