Provider Demographics
NPI:1164467197
Name:RUBIN, PETER HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:HENRY
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0208
Mailing Address - Country:US
Mailing Address - Phone:212-535-3400
Mailing Address - Fax:212-861-1829
Practice Address - Street 1:920 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0208
Practice Address - Country:US
Practice Address - Phone:212-535-3400
Practice Address - Fax:212-861-1829
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109193174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11670Medicare UPIN