Provider Demographics
NPI:1194272757
Name:RUBIO, EMILIO MANUEL (RN)
Entity type:Individual
Prefix:
First Name:EMILIO
Middle Name:MANUEL
Last Name:RUBIO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MERRICK RD
Mailing Address - Street 2:APT 2
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2754
Mailing Address - Country:US
Mailing Address - Phone:516-406-5134
Mailing Address - Fax:
Practice Address - Street 1:140 MERRICK RD
Practice Address - Street 2:APT 2
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2754
Practice Address - Country:US
Practice Address - Phone:516-406-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY719411163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse