Provider Demographics
NPI:1841361615
Name:RUBIN, EDWARD JAY (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAY
Last Name:RUBIN
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 FASHION AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10123-0101
Mailing Address - Country:US
Mailing Address - Phone:212-868-7676
Mailing Address - Fax:212-868-2053
Practice Address - Street 1:450 FASHION AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10123-0101
Practice Address - Country:US
Practice Address - Phone:212-868-7676
Practice Address - Fax:212-868-2053
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice