Provider Demographics
NPI:1922042175
Name:RUBINOVICH, ROBERT MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MITCHELL
Last Name:RUBINOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E CHESTNUT ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2834
Mailing Address - Country:US
Mailing Address - Phone:315-338-9200
Mailing Address - Fax:315-338-9202
Practice Address - Street 1:107 E CHESTNUT ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2834
Practice Address - Country:US
Practice Address - Phone:315-338-9200
Practice Address - Fax:315-338-9202
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199009-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01476397Medicaid
NY10103694OtherCDPHP
NY792839OtherMVP
BA0788Medicare ID - Type Unspecified
NY01476397Medicaid