Provider Demographics
NPI:1285838110
Name:RUBIN, LOUELLA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:LOUELLA
Middle Name:
Last Name:RUBIN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SUSSEX RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1424
Mailing Address - Country:US
Mailing Address - Phone:516-616-7150
Mailing Address - Fax:
Practice Address - Street 1:4 RIVER RD
Practice Address - Street 2:APT. 7D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-1109
Practice Address - Country:US
Practice Address - Phone:212-223-0397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY441194163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse