Provider Demographics
NPI:1912248196
Name:MARCONI, RUBI (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUBI
Middle Name:
Last Name:MARCONI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20960 45TH DR
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3232
Mailing Address - Country:US
Mailing Address - Phone:718-704-3126
Mailing Address - Fax:
Practice Address - Street 1:3439 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2147
Practice Address - Country:US
Practice Address - Phone:607-798-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02530100122300000X
NY056965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist