Provider Demographics
NPI:1154469799
Name:RUBE, GERALD S (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:S
Last Name:RUBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 55TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1824
Mailing Address - Country:US
Mailing Address - Phone:718-435-3300
Mailing Address - Fax:347-240-9049
Practice Address - Street 1:1617 55TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1824
Practice Address - Country:US
Practice Address - Phone:718-435-3300
Practice Address - Fax:347-240-9049
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125262207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00477909Medicaid
NY29A181Medicare ID - Type Unspecified
NY00477909Medicaid