=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831218460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY M. RUBIN, O.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 09/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 OLD TURNPIKE RD SUITE 201
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-2461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-623-3500
-----------------------------------------------------
Fax | 845-623-2223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 OLD TURNPIKE RD SUITE 201
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-2461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-623-3500
-----------------------------------------------------
Fax | 845-623-2223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JEFFREY MARTIN RUBIN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 845-623-3500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 004168
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | 003916
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 152WV0400X
-----------------------------------------------------
Taxonomy Name | Vision Therapy Optometrist
-----------------------------------------------------
License Number | 004168
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 003916
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------