Provider Demographics
NPI:1609919984
Name:RUBELL, BONNIE LYNN
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LYNN
Last Name:RUBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 CHESTER ROAD
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782
Mailing Address - Country:US
Mailing Address - Phone:631-750-3382
Mailing Address - Fax:
Practice Address - Street 1:1227 2 MONTAUK HIGHWAY
Practice Address - Street 2:TENDER AGE PT INC
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769
Practice Address - Country:US
Practice Address - Phone:631-218-1545
Practice Address - Fax:631-218-2650
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0021831225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist