Provider Demographics
NPI:1578552170
Name:RUBENZAHL, KNUDSEN & ASSOCIATES PSYCH., SRVCS, P.C.
Entity Type:Organization
Organization Name:RUBENZAHL, KNUDSEN & ASSOCIATES PSYCH., SRVCS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:KNUDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:315-788-3332
Mailing Address - Street 1:22670 SUMMIT DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-788-3332
Mailing Address - Fax:315-788-4584
Practice Address - Street 1:22670 SUMMIT DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-788-3332
Practice Address - Fax:315-788-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009513103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA53558BMedicare ID - Type Unspecified
R5940Medicare UPIN