Basic Information
| Provider Information | |||||||||
| NPI: | 1881692200 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUBACH | ||||||||
| FirstName: | EUGENE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | POB 528 | ||||||||
| Address2: | |||||||||
| City: | PORT WASHINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110500528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166292484 | ||||||||
| FaxNumber: | 5166292452 | ||||||||
| Practice Location | |||||||||
| Address1: | 139 PLANDOME ROAD | ||||||||
| Address2: | |||||||||
| City: | MANHASSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110302331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166275262 | ||||||||
| FaxNumber: | 5166270641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2005 | ||||||||
| LastUpdateDate: | 08/03/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 231307 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | 2086X0206X | 231307 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.