Provider Demographics
NPI:1710978093
Name:RUBINOV, TSIPORA (DDS)
Entity Type:Individual
Prefix:
First Name:TSIPORA
Middle Name:
Last Name:RUBINOV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TSIPORA
Other - Middle Name:
Other - Last Name:ABDURAKHMANOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9442 58TH AVE
Mailing Address - Street 2:UNIT G-2 DR TSIPORA RUBINOV
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5149
Mailing Address - Country:US
Mailing Address - Phone:718-699-4660
Mailing Address - Fax:718-699-4694
Practice Address - Street 1:9442 58TH AVE
Practice Address - Street 2:UNITE G-2 PRESTIGE DENTAL
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5149
Practice Address - Country:US
Practice Address - Phone:718-699-4660
Practice Address - Fax:718-699-4694
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047292122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01792910Medicaid