Provider Demographics
NPI:1538155999
Name:DYBNER, RUBEN (MD)
Entity type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:DYBNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10923 71ST RD
Mailing Address - Street 2:BASEMENT
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4849
Mailing Address - Country:US
Mailing Address - Phone:718-544-5670
Mailing Address - Fax:718-520-7105
Practice Address - Street 1:10923 71ST RD
Practice Address - Street 2:BASEMENT
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4849
Practice Address - Country:US
Practice Address - Phone:718-544-5670
Practice Address - Fax:718-520-7105
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099940208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00170865Medicaid
NY00170865Medicaid
NY08199NMedicare PIN
B88635Medicare UPIN