MEDICARE: MS. IRIS C. RUBIN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	378068	NY
2	363LF0000X	Family Nurse Practitioner	F331142	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336265826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRIS C. RUBIN NP

Provider Business Mailing Address
First Line	:	6 HEALTHY WAY
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-5612
Country	:	US
Telephone Number	:	845-647-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 HEALTHY WAY
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-5612
Country	:	US
Telephone Number	:	845-647-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	01/04/2019

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