Provider Demographics
NPI:1700046034
Name:RUBANO, JERRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:A
Last Name:RUBANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL RD STE 106
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-8811
Mailing Address - Country:US
Mailing Address - Phone:631-228-5800
Mailing Address - Fax:929-455-9828
Practice Address - Street 1:100 HOSPITAL RD STE 106
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-8811
Practice Address - Country:US
Practice Address - Phone:631-228-5800
Practice Address - Fax:929-455-9828
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261957208600000X, 2086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery