Provider Demographics
NPI:1164530853
Name:RUBIN, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:RUBIN
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 1:95 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2720
Mailing Address - Country:US
Mailing Address - Phone:607-798-7164
Mailing Address - Fax:607-798-0879
Practice Address - Street 1:95 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2720
Practice Address - Country:US
Practice Address - Phone:607-798-7164
Practice Address - Fax:607-798-0879
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101191-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB79496Medicare UPIN
NY31982BMedicare ID - Type Unspecified
NY1256630001Medicare NSC