Provider Demographics
NPI:1568967727
Name:RUBIO, MICHAEL E (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:RUBIO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:607 HALSEY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1201
Mailing Address - Country:US
Mailing Address - Phone:646-493-9548
Mailing Address - Fax:646-222-8784
Practice Address - Street 1:607 HALSEY ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1201
Practice Address - Country:US
Practice Address - Phone:646-493-9548
Practice Address - Fax:646-222-8784
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY021899363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0554076Medicaid