Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 59392 | MA |
NPI | 1003805599 |
---|---|
Provider Name | Jessica Rae Rubinstein |
First Address | Boston, MA 02109-4806 |
Second Address | Concord, MA 01742-2188 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3048381 | (05) | MA |
E19413 | (02) | MA |