Provider Demographics
NPI:1972663656
Name:RUBIN, JEFFREY STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STEWART
Last Name:RUBIN
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 1:1660 EAST 14TH STREET
Mailing Address - Street 2:SUITE LL 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1170
Mailing Address - Country:US
Mailing Address - Phone:718-339-6622
Mailing Address - Fax:718-339-4576
Practice Address - Street 1:1660 EAST 14TH STREET
Practice Address - Street 2:SUITE LL 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1170
Practice Address - Country:US
Practice Address - Phone:718-339-6622
Practice Address - Fax:718-339-4576
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183574207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01465847Medicaid
NY01465847Medicaid
69T77Medicare ID - Type Unspecified