Provider Demographics
NPI:1396749651
Name:RUBIN, JEFFREY M (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:RUBIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 OLD TURNPIKE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2450
Mailing Address - Country:US
Mailing Address - Phone:845-623-3500
Mailing Address - Fax:845-623-2223
Practice Address - Street 1:55 OLD TURNPIKE RD
Practice Address - Street 2:STE 201
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2450
Practice Address - Country:US
Practice Address - Phone:845-623-3500
Practice Address - Fax:845-623-2223
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003916152W00000X, 152WC0802X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY397349OtherUNITED HEALTHCARE
NY5118769OtherCIGNA
NY90580OtherAETNA
C31061OtherBLUE CROSS
NY2C9484OtherHEALTHNET
NY901131OtherBLOCK VISION
NYP1068808OtherOXFORD
NY2C9484OtherHEALTHNET
NY397349OtherUNITED HEALTHCARE
NY5118769OtherCIGNA