Provider Demographics
NPI:1164410361
Name:INGBER, REUBEN SIMON
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:SIMON
Last Name:INGBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 LEXINGTON AVENUE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3540
Mailing Address - Country:US
Mailing Address - Phone:212-213-0001
Mailing Address - Fax:212-213-4629
Practice Address - Street 1:285 LEXINGTON AVENUE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3540
Practice Address - Country:US
Practice Address - Phone:212-213-0001
Practice Address - Fax:212-213-4629
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1464272081P2900X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
33D961Medicare PIN
B13138Medicare UPIN