Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 024589 | CT |
N | 207U00000X | Nuclear Medicine Specialist | 204589 | CT |
NPI | 1245339274 |
---|---|
Provider Name | Fred Rubin |
First Address | Rocky Hill, CT 06067-0587 |
Second Address | Wethersfield, CT 06109-4362 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 03/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00124589300 | (05) | CT |
B39373 | (02) | CT |