Provider Demographics
NPI:1710204235
Name:ADVANCE OB GYN CARE PLLC
Entity Type:Organization
Organization Name:ADVANCE OB GYN CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-396-3241
Mailing Address - Street 1:PO BOX 5206
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-5206
Mailing Address - Country:US
Mailing Address - Phone:718-725-7203
Mailing Address - Fax:615-634-5504
Practice Address - Street 1:9207 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7941
Practice Address - Country:US
Practice Address - Phone:718-396-3241
Practice Address - Fax:718-396-3173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty