MEDICARE: DIMETRIS ROUBIS PA

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	363A00000X	Physician Assistant	005795	NY

General Provider Information

NPI Number	:	1427074756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIMETRIS ROUBIS PA

Provider Business Mailing Address
First Line	:	1 HOLLOW LN
Second Line	:	SUITE 110-NORTH SHORE ALLERGY & ASTHMA INSTITUTE
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1215
Country	:	US
Telephone Number	:	516-365-6666
Fax Number	:	516-869-1123

Provider Business Practice Location Address
First Line	:	1 HOLLOW LN
Second Line	:	SUITE 110-NORTH SHORE ALLERGY & ASTHMA INSTITUTE
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1215
Country	:	US
Telephone Number	:	516-365-6666
Fax Number	:	516-869-1123

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	12/21/2010

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