Provider Demographics
NPI:1437149291
Name:RUBIN, MITCHELL (DPM)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3500
Mailing Address - Country:US
Mailing Address - Phone:914-834-0111
Mailing Address - Fax:914-834-0259
Practice Address - Street 1:2365 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3500
Practice Address - Country:US
Practice Address - Phone:914-834-0111
Practice Address - Fax:914-834-0259
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04132213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0098513-2Medicaid
NY058-2761OtherAETNA GOLDEN MEDICARE
NYRS048OtherOXFORD
NY37050OtherGHI HMO
NY1C1595OtherPHS
NY0048654OtherGHI
NYP4359OtherBLUE CHOICE
NY582-761OtherUS HEALTH
NY0582761OtherAETNA US HEALTHCARE
NY582-761OtherUS HEALTH
NY37050OtherGHI HMO