MEDICARE: DR. SHULAMIT RUBIN PH.D.

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	103TC0700X	Clinical Psychologist	014753	NY

General Provider Information

NPI Number	:	1659586535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHULAMIT RUBIN PH.D.

Provider Business Mailing Address
First Line	:	200 W 90TH ST
Second Line	:	APT 6B
City	:	NEW YORK
State	:	NY
Zip	:	10024-1234
Country	:	US
Telephone Number	:	212-595-2019
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 COLLEGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-3002
Country	:	US
Telephone Number	:	718-549-4888
Fax Number	:

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

Provider Enumeration Date	:	05/13/2007
Last Update Date	:	07/08/2007

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