Provider Demographics
NPI:1003177270
Name:RUBIN, DEBRA B
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:B
Last Name:RUBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PONY CIR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1980
Mailing Address - Country:US
Mailing Address - Phone:516-484-3031
Mailing Address - Fax:
Practice Address - Street 1:17 PONY CIR
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1980
Practice Address - Country:US
Practice Address - Phone:516-484-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26857061174400000X
NY574926111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist