Provider Demographics
NPI:1336265826
Name:RUBIN, IRIS C (NP)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:C
Last Name:RUBIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:IRIS
Other - Middle Name:C
Other - Last Name:ARIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6 HEALTHY WAY
Mailing Address - Street 2:
Mailing Address - City:ELLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12428-5612
Mailing Address - Country:US
Mailing Address - Phone:845-647-4500
Mailing Address - Fax:
Practice Address - Street 1:6 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-5612
Practice Address - Country:US
Practice Address - Phone:845-647-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY378068163W00000X
NYF331142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03167993Medicaid