Provider Demographics
NPI:1750447785
Name:RUBIN, ROBERT D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4652
Mailing Address - Country:US
Mailing Address - Phone:718-868-1497
Mailing Address - Fax:718-868-2600
Practice Address - Street 1:833 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4652
Practice Address - Country:US
Practice Address - Phone:718-868-1497
Practice Address - Fax:718-868-2600
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38848-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01067647Medicaid