Provider Demographics
NPI:1962429969
Name:LAUREEN FORGIONE RUBINO, M.D., LLC
Entity type:Organization
Organization Name:LAUREEN FORGIONE RUBINO, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORGIONE RUBINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-645-1232
Mailing Address - Street 1:945 MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6064
Mailing Address - Country:US
Mailing Address - Phone:860-645-1232
Mailing Address - Fax:860-647-0438
Practice Address - Street 1:945 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6064
Practice Address - Country:US
Practice Address - Phone:860-645-1232
Practice Address - Fax:860-647-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010033061CT01OtherANTHEM BC/BS
CT020046417OtherRAILROADMEDICARE
CT010036834CT01OtherANTHEM BC/BS
CT033061OtherCONNECTICARE
CT2225252OtherAETNA
CTOV5259OtherHEALTH NET
CT00136834000Medicaid
CT036834OtherCONNECTICARE
CT3716523OtherAETNA
CT2V6079OtherHEALTHNET
CTP1991984OtherOXFORD
CT00133061200Medicaid
CTP3564749OtherOXFORD
CT3788171OtherCIGNA
CT5664714002OtherCIGNA
CT010036834CT01OtherANTHEM BC/BS
CT020001635Medicare ID - Type Unspecified
CT00136834000Medicaid
CT00133061200Medicaid