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Provider Information for 1073634564



DR. JEFFREY LEE RUBIN D.M.D.

Gender: MALE

Individual NPI: 1073634564

Calendar Last Updated: 2007-07-08

Details

Name Value
NPI 1073634564
Enumeration Date 2007-04-02
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 21 BARSTOW RD SUITE 1-B
GREAT NECK, NY 11021-2215
United States

Phone: 516-487-1807 | Fax: 516-487-1863
View Map External Link
Primary Practice Address 21 BARSTOW RD SUITE 1-B
GREAT NECK, NY 11021-2215
United States

Phone: 516-487-1807 | Fax: 516-487-1863
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice NY 36463
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location