Provider Demographics
NPI:1740333202
Name:RUBIN, ERIC (MD PHD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 CENTRAL PARK W STE 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3512
Mailing Address - Country:US
Mailing Address - Phone:212-579-6647
Mailing Address - Fax:212-496-5673
Practice Address - Street 1:262 CENTRAL PARK W STE 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3512
Practice Address - Country:US
Practice Address - Phone:212-579-6647
Practice Address - Fax:212-496-5673
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174825-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS2382OtherOXFORD HEALTH PROVIDERID
NYNS2382OtherOXFORD HEALTH PROVIDERID
NY73K701Medicare ID - Type Unspecified