Provider Demographics
NPI:1942974316
Name:RUBINOV, AVRAKHAM (NP)
Entity type:Individual
Prefix:
First Name:AVRAKHAM
Middle Name:
Last Name:RUBINOV
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19805 EPSOM CRSE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1301
Mailing Address - Country:US
Mailing Address - Phone:718-350-6381
Mailing Address - Fax:929-744-7772
Practice Address - Street 1:19805 EPSOM CRSE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1301
Practice Address - Country:US
Practice Address - Phone:718-350-6381
Practice Address - Fax:929-744-7772
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310309363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health