MEDICARE: GENNADY RUBINSTEIN M.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	207N00000X	Dermatology Physician	A74924	CA
2	207NS0135X	Procedural Dermatology Physician	A74924	CA
3	207NP0225X	Pediatric Dermatology Physician	A74924	CA
4	207ND0101X	MOHS-Micrographic Surgery Physician	A74924	CA
5	207ND0900X	Dermatopathology Physician	A74924	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A74924	OTHER	CA	LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720083744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENNADY RUBINSTEIN M.D.

Provider Business Mailing Address
First Line	:	3959 LAUREL CANYON BLVD
Second Line	:	SUITE F
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-4921
Country	:	US
Telephone Number	:	818-505-9300
Fax Number	:	818-505-9292

Provider Business Practice Location Address
First Line	:	3959 LAUREL CANYON BLVD
Second Line	:	SUITE F
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-4921
Country	:	US
Telephone Number	:	818-505-9300
Fax Number	:	818-505-9292

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/07/2008

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