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General NPI Number Information
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NPI Number | 1710204235
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Entity Type | Organization
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Legal Business Name | ADVANCE OB GYN CARE PLLC
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Dates
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Enumeration Date | 04/23/2010
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Last Update Date | 04/23/2010
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Provider Practice Location Address
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Address Line | 9207 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7941
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Country | US
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Telephone | 718-396-3241
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Fax | 718-396-3173
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Provider Business Mailing Address
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Address Line | PO BOX 5206
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City | ASTORIA
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State | NY
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Zip | 11105-5206
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Country | US
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Telephone | 718-725-7203
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Fax | 615-634-5504
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHERMAN RUBIN
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Credential | M.D.
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Telephone | 718-396-3241
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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 |
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License Number State |
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