Provider Demographics
NPI:1942974316
Name:RUBINOV, AVRAKHAM (NP)
Entity Type:Individual
Prefix:
First Name:AVRAKHAM
Middle Name:
Last Name:RUBINOV
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6836 108TH ST APT B58
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-8901
Mailing Address - Country:US
Mailing Address - Phone:718-350-6381
Mailing Address - Fax:
Practice Address - Street 1:6836 108TH ST APT B58
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-8901
Practice Address - Country:US
Practice Address - Phone:718-350-6381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310309363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health