Provider Demographics
NPI:1568582039
Name:RUBIN, ROSE (PA)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:RUBIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5139
Mailing Address - Country:US
Mailing Address - Phone:914-333-5801
Mailing Address - Fax:718-428-6667
Practice Address - Street 1:3629 BELL BLVD STE 202
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2056
Practice Address - Country:US
Practice Address - Phone:914-333-5801
Practice Address - Fax:718-428-6667
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY008133363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical