Provider Demographics
NPI:1114297058
Name:RUBINO, ALFRED DEAN (ANP-BC)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:DEAN
Last Name:RUBINO
Suffix:
Gender:M
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 JONATHAN DR
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3885
Mailing Address - Country:US
Mailing Address - Phone:860-858-5089
Mailing Address - Fax:860-858-5089
Practice Address - Street 1:500 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3913
Practice Address - Country:US
Practice Address - Phone:860-858-5089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004889363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health