Provider Demographics
NPI:1558352039
Name:RUBENSTEIN, STEPHEN ERROL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ERROL
Last Name:RUBENSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-4403
Mailing Address - Country:US
Mailing Address - Phone:718-387-1365
Mailing Address - Fax:718-486-5733
Practice Address - Street 1:722 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4403
Practice Address - Country:US
Practice Address - Phone:718-387-1365
Practice Address - Fax:718-486-5733
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0271291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00288151Medicaid