Provider Demographics
NPI:1922391564
Name:BARRY RUBIN M.D.,P.C.
Entity Type:Organization
Organization Name:BARRY RUBIN M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-246-9501
Mailing Address - Street 1:46 ROUTE 25A
Mailing Address - Street 2:STE 4
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733
Mailing Address - Country:US
Mailing Address - Phone:631-246-9501
Mailing Address - Fax:631-246-9570
Practice Address - Street 1:46 ROUTE 25A
Practice Address - Street 2:STE 4
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2820
Practice Address - Country:US
Practice Address - Phone:631-246-9501
Practice Address - Fax:631-246-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1697941174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE76287Medicare PIN
NY78F881Medicare UPIN