Provider Demographics
NPI:1851372767
Name:RUBINOWITZ, AMI NATASHA (MD)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:NATASHA
Last Name:RUBINOWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:YNHH - SOUTH PAVILION, 2ND FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-688-2433
Mailing Address - Fax:203-688-9258
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YNHH - SOUTH PAVILION, 2ND FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2433
Practice Address - Fax:203-688-9258
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0430582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001430587Medicaid
CT001430587Medicaid
CT300003611Medicare ID - Type Unspecified