Basic Information
| Provider Information | |||||||||
| NPI: | 1285714196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBIN | ||||||||
| FirstName: | GIL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 ALEXANDER ST | ||||||||
| Address2: | STE 5000 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859228003 | ||||||||
| FaxNumber: | 5859228150 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 ALEXANDER ST | ||||||||
| Address2: | STE 5000 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146074039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859228003 | ||||||||
| FaxNumber: | 5859228150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 01/27/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 220808 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00413460 | 01 | NY | RAILROAD MEDICARE | OTHER | 02165039 | 05 | NY | MEDICAID |