Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 138607 | NY |
NPI | 1023142742 |
---|---|
Provider Name | Dr. Allen Rubin |
First Address | Lawrence, NY 11559 |
Second Address | Lawrence, NY 11559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 24/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00774718 | (05) | NY |
C12039 | (02) |