Provider Demographics
NPI:1962650770
Name:RUBIN, ZDENA (MD)
Entity Type:Individual
Prefix:
First Name:ZDENA
Middle Name:
Last Name:RUBIN
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 1:203 W 12TH ST
Mailing Address - Street 2:ROOM 450
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7762
Mailing Address - Country:US
Mailing Address - Phone:212-604-2578
Mailing Address - Fax:212-604-2547
Practice Address - Street 1:203 W 12TH ST
Practice Address - Street 2:ROOM 450
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7762
Practice Address - Country:US
Practice Address - Phone:212-604-2578
Practice Address - Fax:212-604-2547
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08593600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist