Provider Demographics
NPI:1699936534
Name:RUBIN, JESSICA ILYSHA (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ILYSHA
Last Name:RUBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:825 NORTHERN BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5321
Mailing Address - Country:US
Mailing Address - Phone:516-472-5700
Mailing Address - Fax:516-472-5703
Practice Address - Street 1:825 NORTHERN BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5321
Practice Address - Country:US
Practice Address - Phone:516-472-5700
Practice Address - Fax:516-472-5703
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2012-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY253796207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology