Provider Demographics
NPI:1477116457
Name:REUBEN, CAROLINE S (HHA)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:S
Last Name:REUBEN
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17108 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5428
Mailing Address - Country:US
Mailing Address - Phone:718-269-8222
Mailing Address - Fax:347-238-1251
Practice Address - Street 1:17108 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5428
Practice Address - Country:US
Practice Address - Phone:718-269-8222
Practice Address - Fax:718-480-6150
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2082444311ZA0620X
NY2082444DCA311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06057914Medicaid