Provider Demographics
NPI:1366559809
Name:RUBIN, LAURENCE (MD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:
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 1:4277 HEMPSTEAD TPKE
Mailing Address - Street 2:109
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714
Mailing Address - Country:US
Mailing Address - Phone:516-796-4030
Mailing Address - Fax:516-796-5134
Practice Address - Street 1:4277 HEMPSTEAD TPKE
Practice Address - Street 2:109
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-796-4030
Practice Address - Fax:516-796-5134
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146480207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16D14CK121Medicare PIN
C06126Medicare UPIN