Provider Demographics
NPI:1992837223
Name:RUBIN, JEFFREY I (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:I
Last Name:RUBIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 CENTENNIAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1917
Mailing Address - Country:US
Mailing Address - Phone:516-867-2202
Mailing Address - Fax:516-867-7448
Practice Address - Street 1:916 CENTENNIAL AVENUE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1917
Practice Address - Country:US
Practice Address - Phone:516-867-2202
Practice Address - Fax:516-867-7448
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7839103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00827225Medicaid
NY00827225Medicaid