Provider Demographics
NPI:1457307480
Name:RUBERT, ANDRES I JR (MD)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:I
Last Name:RUBERT
Suffix:JR
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 1:411 CANISTEO ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-2104
Mailing Address - Country:US
Mailing Address - Phone:607-324-0604
Mailing Address - Fax:
Practice Address - Street 1:411 CANISTEO ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-2104
Practice Address - Country:US
Practice Address - Phone:607-324-0604
Practice Address - Fax:607-324-8293
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196988207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01552987Medicaid
NY01552987Medicaid