Provider Demographics
NPI:1669697793
Name:RUBIN, ALAN LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LAWRENCE
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1233 BEECH ST
Mailing Address - Street 2:#48
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11509-1600
Mailing Address - Country:US
Mailing Address - Phone:516-897-0277
Mailing Address - Fax:
Practice Address - Street 1:2270 KIMBALL ST
Practice Address - Street 2:SUITE 206
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5139
Practice Address - Country:US
Practice Address - Phone:516-897-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1510932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51D693Medicare ID - Type Unspecified
NYG00511Medicare UPIN