Provider Demographics
NPI:1679514228
Name:RUBENSTEIN, ROY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:ALAN
Last Name:RUBENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 ATLANTIC AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11510
Mailing Address - Country:US
Mailing Address - Phone:516-623-8700
Mailing Address - Fax:516-523-3746
Practice Address - Street 1:920 ATLANTIC AVENUE
Practice Address - Street 2:
Practice Address - City:BALDWIN HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-623-8700
Practice Address - Fax:516-523-3746
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141133174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC04652Medicare UPIN
NYW11141Medicare PIN
C04652Medicare UPIN