Provider Demographics
NPI:1487785390
Name:RUBIO, ENRIQUE MATIAS (MD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:MATIAS
Last Name:RUBIO
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 1:330 EAST 91 STREET
Mailing Address - Street 2:1 F
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5319
Mailing Address - Country:US
Mailing Address - Phone:212-996-9387
Mailing Address - Fax:212-996-9387
Practice Address - Street 1:330 EAST 91 STREET
Practice Address - Street 2:1 F
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10128-5319
Practice Address - Country:US
Practice Address - Phone:212-996-9387
Practice Address - Fax:212-996-9387
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1823462084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry