Provider Demographics
NPI:1073634564
Name:RUBIN, JEFFREY LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEE
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BARSTOW RD
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2215
Mailing Address - Country:US
Mailing Address - Phone:516-487-1807
Mailing Address - Fax:516-487-1863
Practice Address - Street 1:21 BARSTOW RD
Practice Address - Street 2:SUITE 1-B
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2215
Practice Address - Country:US
Practice Address - Phone:516-487-1807
Practice Address - Fax:516-487-1863
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY364631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice