Provider Demographics
NPI:1033391768
Name:MARK P RUBINO MD LLC
Entity Type:Organization
Organization Name:MARK P RUBINO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:P
Authorized Official - Last Name:RUBINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-261-6876
Mailing Address - Street 1:848 1ST AVE N STE 340
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6063
Mailing Address - Country:US
Mailing Address - Phone:239-261-6876
Mailing Address - Fax:239-643-4969
Practice Address - Street 1:848 1ST AVE N STE 340
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6063
Practice Address - Country:US
Practice Address - Phone:239-261-6876
Practice Address - Fax:239-643-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75629174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDE5164OtherMEDICARE RAILROAD GROUP
FLE2203TOtherINDIVIUAL MEDICARE PIN
FLP00297710OtherMEDICARE RAILROAD PIN
FL10D2014426OtherCLIA LICENSE
FL49182OtherBCBS OF FL
FLE2203TOtherINDIVIUAL MEDICARE PIN