MEDICARE: MS. JILL ZOE RUBIN LCSW

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	1041C0700X	Clinical Social Worker	PR013001-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PR013001-1	OTHER	NY	SOCIAL WORK LICENSE NUMBE

General Provider Information

NPI Number	:	1568536704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL ZOE RUBIN LCSW

Provider Business Mailing Address
First Line	:	30 5TH AVE
Second Line	:	APT. 14D
City	:	NEW YORK
State	:	NY
Zip	:	10011-8859
Country	:	US
Telephone Number	:	212-677-1461
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 UNIVERSITY PL
Second Line	:	SUITE 3
City	:	NEW YORK
State	:	NY
Zip	:	10003-4564
Country	:	US
Telephone Number	:	212-677-1461
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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