Provider Demographics
NPI:1063556447
Name:RUBIN, NEIL MARK (OD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:MARK
Last Name:RUBIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:33 SHERWOOD FRST APT C
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5726
Mailing Address - Country:US
Mailing Address - Phone:845-298-1288
Mailing Address - Fax:
Practice Address - Street 1:2001 SOUTH RD
Practice Address - Street 2:SUITE A-206
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5978
Practice Address - Country:US
Practice Address - Phone:845-298-1288
Practice Address - Fax:845-298-1280
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3669152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU34967Medicare UPIN
NYC61001Medicare ID - Type Unspecified