Provider Demographics
NPI:1285871392
Name:RUBIN, KERRY (RPH)
Entity type:Individual
Prefix:MR
First Name:KERRY
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5250
Mailing Address - Country:US
Mailing Address - Phone:631-225-6230
Mailing Address - Fax:631-956-7219
Practice Address - Street 1:455 PARK AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5250
Practice Address - Country:US
Practice Address - Phone:631-225-6230
Practice Address - Fax:631-956-7219
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY031013OtherNYS LICENSE NUMBER