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General NPI Number Information
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NPI Number | 1699936534
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Entity Type | Individual
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Provider Name | JESSICA ILYSHA RUBIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 825 NORTHERN BLVD SUITE 301
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City | GREAT NECK
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State | NY
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Zip | 11021-5321
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Country | US
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Telephone | 516-472-5700
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Fax | 516-472-5703
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Provider Business Mailing Address
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Address Line | 825 NORTHERN BLVD SUITE 301
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City | GREAT NECK
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State | NY
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Zip | 11021-5321
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Country | US
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Telephone | 516-472-5700
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Fax | 516-472-5703
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 253796
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License Number State | NY
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