Provider Demographics
NPI:1366586844
Name:RUBIN, ALLAN B (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:B
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 1:202 TOWN HILL RD
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-5954
Mailing Address - Country:US
Mailing Address - Phone:845-426-6000
Mailing Address - Fax:845-426-6000
Practice Address - Street 1:202 TOWN HILL RD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-5954
Practice Address - Country:US
Practice Address - Phone:845-426-6000
Practice Address - Fax:845-426-6000
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD0972932085R0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD19852Medicare UPIN
05F011Medicare ID - Type Unspecified