Provider Demographics
NPI:1801011747
Name:RUBIN, HAROLD
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W 90TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 W 90TH ST
Practice Address - Street 2:165 WEST 91 STREET
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1109
Practice Address - Country:US
Practice Address - Phone:212-362-0692
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
NY3477101YM0800X
MAPY846-PR103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service