Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 035166 | NY |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 035166 | NY |
NPI | 1003820671 |
---|---|
Provider Name | Dr. Mitchell Myles Rubin |
First Address | Rockville Centre, NY 11570 |
Second Address | Rockville Centre, NY 11570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |