Provider Demographics
NPI:1992040711
Name:RUBELMANN, ALYSON (SP ED TEACHER)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:RUBELMANN
Suffix:
Gender:F
Credentials:SP ED TEACHER
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SP ED TEACHER
Mailing Address - Street 1:6800 PITTSFORD PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3584
Mailing Address - Country:US
Mailing Address - Phone:585-223-5090
Mailing Address - Fax:
Practice Address - Street 1:6800 PITTSFORD PALMYRA RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3584
Practice Address - Country:US
Practice Address - Phone:585-223-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627139121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist