1689854192 NPI number — IAN M. RUBINS, MD, PC

Table of content: (NPI 1689854192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689854192 NPI number — IAN M. RUBINS, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IAN M. RUBINS, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689854192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 DEARFIELD DR
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
GREENWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06831-5351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-618-0687
Provider Business Mailing Address Fax Number:
203-869-0019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 DEARFIELD DR
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
GREENWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06831-5351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-618-0687
Provider Business Practice Location Address Fax Number:
203-869-0019
Provider Enumeration Date:
11/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DONIS
Authorized Official First Name:
ROBERTA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
BILLING ADMINISTRATOR
Authorized Official Telephone Number:
203-618-0687

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  033766 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05676572 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1336207968 . This is a "INDIVIDUAL PROVIDER NPI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P967462 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010033766CT03 . This is a "ANTHEM BCBS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CU1896 . This is a "ACS HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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