Provider Demographics
NPI:1891345666
Name:JRR MEDICAL PC
Entity Type:Organization
Organization Name:JRR MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-210-2960
Mailing Address - Street 1:139 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3933
Mailing Address - Country:US
Mailing Address - Phone:718-210-2960
Mailing Address - Fax:718-744-9374
Practice Address - Street 1:2569 OCEAN AVE STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4576
Practice Address - Country:US
Practice Address - Phone:718-210-2960
Practice Address - Fax:718-744-9374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY280210OtherSTATE LICENSE