Provider Demographics
NPI:1073624490
Name:KAYSON-RUBIN, ELISE (NP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:KAYSON-RUBIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3917
Mailing Address - Country:US
Mailing Address - Phone:585-275-8503
Mailing Address - Fax:585-276-2249
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 278984
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-8503
Practice Address - Fax:585-276-2249
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301583-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11145AMedicare PIN