Provider Demographics
NPI:1326120601
Name:RUBIN, BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
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 1:46 ROUTE 25A
Mailing Address - Street 2:SUTIE 4
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2820
Mailing Address - Country:US
Mailing Address - Phone:631-246-9501
Mailing Address - Fax:631-246-9570
Practice Address - Street 1:635 BELLE TERRE RD STE 209B
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1935
Practice Address - Country:US
Practice Address - Phone:631-246-9501
Practice Address - Fax:631-246-9570
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169794-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY911050OtherPHS
NY10173OtherANTHEM #
NYP-34032414OtherMULTIPLAN
NY10514507OtherCAQH
NY27313OtherMASTER CARE
NYP383718OtherOXFORD PROVIDER#
NY76235OtherVYTRA PROVIDER #
NY250010334OtherRAILROAD MEDICARE
NY1078638000OtherDEPT OF LABOR
NY205383OtherHIP
NY4330561OtherAETNA PIN #
NYCIGNAOther43165004
NYP383718OtherOXFORD PROVIDER#
NY911050OtherPHS