Provider Demographics
NPI:1720083744
Name:RUBINSTEIN, GENNADY (MD)
Entity Type:Individual
Prefix:
First Name:GENNADY
Middle Name:
Last Name:RUBINSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:RUBINSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3959 LAUREL CANYON BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4921
Mailing Address - Country:US
Mailing Address - Phone:818-505-9300
Mailing Address - Fax:818-505-9292
Practice Address - Street 1:3959 LAUREL CANYON BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-4921
Practice Address - Country:US
Practice Address - Phone:818-505-9300
Practice Address - Fax:818-505-9292
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74924207N00000X, 207NS0135X, 207NP0225X, 207ND0101X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA74924OtherLICENSE NUMBER
CA00A749240Medicaid
CA00A749240Medicaid
CAA74924Medicare PIN