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NPI Code Detail

MEDICARE: DIMETRIS ROUBIS PA

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
1363A00000XPhysician Assistant005795NY

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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Directions to “ DIMETRIS ROUBIS PA” Practice Location

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