Provider Demographics
NPI:1972628238
Name:IRA RUBENFELD, MD, PC
Entity type:Organization
Organization Name:IRA RUBENFELD, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:RUBENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-955-9294
Mailing Address - Street 1:1015 CHESTNUT ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4316
Mailing Address - Country:US
Mailing Address - Phone:215-955-9294
Mailing Address - Fax:215-955-0962
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4316
Practice Address - Country:US
Practice Address - Phone:215-955-9294
Practice Address - Fax:215-955-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025243E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB41262Medicare UPIN