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General NPI Number Information
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NPI Number | 1598136145
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Entity Type | Organization
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Legal Business Name | PATCHOGUE ORTHODONTICS, PC
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 240 PATCHOGUE YAPHANK RD
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4868
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Country | US
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Telephone | 631-447-7623
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Fax | 631-289-3363
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Provider Business Mailing Address
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Address Line | 240 PATCHOGUE YAPHANK RD
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4868
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Country | US
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Telephone | 631-447-7623
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Fax | 631-289-3363
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT RUBIN
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Credential | DDS
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Telephone | 631-447-7623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 38848-1
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License Number State | NY
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