Provider Demographics
NPI:1750325668
Name:RUBIN, RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 BROADWAY
Mailing Address - Street 2:STE #2
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701
Mailing Address - Country:US
Mailing Address - Phone:845-794-7741
Mailing Address - Fax:845-794-0228
Practice Address - Street 1:427 BROADWAY
Practice Address - Street 2:STE #2
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701
Practice Address - Country:US
Practice Address - Phone:845-794-7741
Practice Address - Fax:845-794-0228
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3603213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0786443Medicaid
NYP37301Medicare ID - Type Unspecified
NY0786443Medicaid