Provider Demographics
NPI:1811035488
Name:RUBENSTEIN, SUZANNE JILL (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:JILL
Last Name:RUBENSTEIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8509 151ST AVE
Mailing Address - Street 2:APT LL
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1301
Mailing Address - Country:US
Mailing Address - Phone:718-641-7055
Mailing Address - Fax:718-845-8634
Practice Address - Street 1:8509 151ST AVE
Practice Address - Street 2:APT LL
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1301
Practice Address - Country:US
Practice Address - Phone:718-641-7055
Practice Address - Fax:718-845-8634
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0392831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice