Provider Demographics
NPI:1205827714
Name:RUBIN, LESLIE B (DPM)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:B
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5676 RIVERDALE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RIVERDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2138
Mailing Address - Country:US
Mailing Address - Phone:718-549-2700
Mailing Address - Fax:
Practice Address - Street 1:5676 RIVERDALE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:RIVERDALE
Practice Address - State:NY
Practice Address - Zip Code:10471-2138
Practice Address - Country:US
Practice Address - Phone:718-549-2700
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003119213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist