Organization
CHAMPLAIN VALLEY PSYCHIATRIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAL IRA RUBIN MD (PHYSICIAN OWNER PARTNER)
(518) 561-0063
Entity
Organization
Contact information
Practice address
11 HAMMOND LANE, SUITE A, PLATTSBURGH, NY 12901-2003
(518) 561-0063
(518) 561-0947
Mailing address
11 HAMMOND LANE, SUITE A, PLATTSBURGH, NY 12901-2003
(518) 561-0063
(518) 561-0947
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP490098001
BLUESHIELD OF NORTHEASTERN NY
NY
Enumeration date
11/07/2006
Last updated
07/01/2010
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