Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 017303 | NY |
Y | 103T00000X | Psychologist | 017303 | NY |
NPI | 1003354069 |
---|---|
Provider Name | James Rubin-Perez |
First Address | Huntington, NY 11743-4117 |
Second Address | Huntington, NY 11743-4117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2017 |
Last Update Date | 09/02/2017 |