Provider Demographics
NPI:1326048653
Name:RUBIN, HAL IRA (MD)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:IRA
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 1:11 HAMMOND LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2003
Mailing Address - Country:US
Mailing Address - Phone:518-561-0063
Mailing Address - Fax:518-561-0947
Practice Address - Street 1:11 HAMMOND LN
Practice Address - Street 2:SUITE A
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2003
Practice Address - Country:US
Practice Address - Phone:518-561-0063
Practice Address - Fax:518-561-0947
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183085-12084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01201216Medicaid
NY209117OtherMVP
8101940OtherGHI
000405146001OtherBSNE NY
NY137057OtherVALUE OPTIONS
8101940OtherGHI
NY137057OtherVALUE OPTIONS