Provider Demographics
NPI:1275659351
Name:CRAIG S RUBENSTEIN DC PC
Entity Type:Organization
Organization Name:CRAIG S RUBENSTEIN DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUBENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-213-9494
Mailing Address - Street 1:258 GRANNY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3013
Mailing Address - Country:US
Mailing Address - Phone:631-696-2039
Mailing Address - Fax:631-451-1733
Practice Address - Street 1:71 PARK AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2507
Practice Address - Country:US
Practice Address - Phone:212-213-9494
Practice Address - Fax:212-213-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005828-1111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU06496Medicare UPIN