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General NPI Number Information
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NPI Number | 1871069484
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Entity Type | Individual
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Provider Name | CHRISTOPHER HART RUBINO RT (R), PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 11/09/2018
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Provider Practice Location Address
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Address Line | 200 BELLE TERRE RD # 474-6000
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1968
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Country | US
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Telephone | 631-474-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 40 SCUDDER AVE # 2E
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City | NORTHPORT
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State | NY
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Zip | 11768-2915
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Country | US
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Telephone | 631-987-0175
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 022771-1
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License Number State | NY
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