Provider Demographics
NPI:1427197391
Name:JACK M. RUBENSTEIN, MD
Entity Type:Organization
Organization Name:JACK M. RUBENSTEIN, MD
Other - Org Name:CENTER FOR DIAGNOSTIC CONSULTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:RUBENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-256-6649
Mailing Address - Street 1:900 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2145
Mailing Address - Country:US
Mailing Address - Phone:516-256-6649
Mailing Address - Fax:516-256-6653
Practice Address - Street 1:900 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2145
Practice Address - Country:US
Practice Address - Phone:516-256-6649
Practice Address - Fax:516-256-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC2393891Medicaid
NY103AD1Medicare ID - Type UnspecifiedMEDICARE
NYC2393891Medicaid