Provider Demographics
NPI:1043728058
Name:R MITCHELL RUBINOVICH MD PLLC
Entity Type:Organization
Organization Name:R MITCHELL RUBINOVICH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-207-4222
Mailing Address - Street 1:1109 N GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3415
Mailing Address - Country:US
Mailing Address - Phone:315-207-4222
Mailing Address - Fax:315-533-4377
Practice Address - Street 1:1109 N GEORGE ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3415
Practice Address - Country:US
Practice Address - Phone:315-207-4222
Practice Address - Fax:315-533-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199009207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty