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General NPI Number Information
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NPI Number | 1619904174
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Entity Type | Individual
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Provider Name | JACK D RUBIN MD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 161 WEST 61ST STREET, APT. 18B
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City | NEW YORK CITY
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State | NY
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Zip | 10023
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Country | US
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Telephone | 732-846-2777
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Fax | 732-828-1950
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Provider Business Mailing Address
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Address Line | 161 WEST 61ST STREET APT. 18B
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City | NEW YORK CITY
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State | NY
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Zip | 10023
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Country | US
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Telephone | 732-846-2777
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Fax | 732-828-1950
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 086041
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License Number State | NY
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