Provider Demographics
NPI:1487673877
Name:RUBENSTEIN, CRAIG S (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
Last Name:RUBENSTEIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 GRANNY RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3013
Mailing Address - Country:US
Mailing Address - Phone:631-696-2039
Mailing Address - Fax:631-451-1733
Practice Address - Street 1:258 GRANNY RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3013
Practice Address - Country:US
Practice Address - Phone:631-696-2039
Practice Address - Fax:631-451-1733
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005828-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU06496Medicare UPIN