Provider Demographics
NPI:1124189543
Name:RUBINSTEIN, ELLEN E (PSYD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:E
Last Name:RUBINSTEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SQUADRON BLVD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-639-4980
Mailing Address - Fax:845-369-1301
Practice Address - Street 1:20 SQUADRON BLVD
Practice Address - Street 2:SUITE 470
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-639-4980
Practice Address - Fax:845-369-1301
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0126021103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV35312Medicare ID - Type Unspecified