Provider Demographics
NPI:1326297151
Name:RUBINOV, KONSTANTIN
Entity Type:Individual
Prefix:DR
First Name:KONSTANTIN
Middle Name:
Last Name:RUBINOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 N 7TH ST
Mailing Address - Street 2:APT #2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2101
Mailing Address - Country:US
Mailing Address - Phone:917-903-3108
Mailing Address - Fax:
Practice Address - Street 1:8961 164TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5141
Practice Address - Country:US
Practice Address - Phone:917-903-3108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05417811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice