MEDICARE: JILLIAN M RUBIN PA-C

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	019232	NY

General Provider Information

NPI Number	:	1588035737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN M RUBIN PA-C

Provider Business Mailing Address
First Line	:	200 E END AVE APT 5JK
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-7831
Country	:	US
Telephone Number	:	516-672-3272
Fax Number	:

Provider Business Practice Location Address
First Line	:	171A E 65TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6607
Country	:	US
Telephone Number	:	212-223-1025
Fax Number	:

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

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	09/29/2022

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Directions to “ JILLIAN M RUBIN PA-C” Practice Location

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