Provider Demographics
NPI:1548281926
Name:RUBENSTEIN, FORREST SCOT (MD)
Entity type:Individual
Prefix:DR
First Name:FORREST
Middle Name:SCOT
Last Name:RUBENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3810 NORTHDALE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1871
Mailing Address - Country:US
Mailing Address - Phone:813-961-1331
Mailing Address - Fax:888-850-8316
Practice Address - Street 1:295 NW PEACOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2212
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:888-812-8191
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.121627208600000X, 208G00000X, 208G00000X
VA01012512012086S0129X
NJ25MA09455300208G00000X, 208G00000X
FLME1330232086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0440124Medicaid
FL100424300Medicaid
NY04629998Medicaid
C70978Medicare UPIN