MEDICARE: DR. RUBEN DYBNER MD

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	208800000X	Urology Physician	099940	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	:	1538155999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBEN DYBNER MD

Provider Business Mailing Address
First Line	:	10923 71ST RD
Second Line	:	BASEMENT
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4849
Country	:	US
Telephone Number	:	718-544-5670
Fax Number	:	718-520-7105

Provider Business Practice Location Address
First Line	:	10923 71ST RD
Second Line	:	BASEMENT
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4849
Country	:	US
Telephone Number	:	718-544-5670
Fax Number	:	718-520-7105

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	11/29/2011

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