Organization
PATCHOGUE ORTHODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT RUBIN DDS (PRESIDENT)
(631) 447-7623
Entity
Organization
Contact information
Practice address
240 PATCHOGUE YAPHANK RD, EAST PATCHOGUE, NY 11772-4868
(631) 447-7623
(631) 289-3363
Mailing address
240 PATCHOGUE YAPHANK RD, EAST PATCHOGUE, NY 11772-4868
(631) 447-7623
(631) 289-3363
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
38848-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01067647
—
NY
Enumeration date
10/08/2015
Last updated
10/08/2015
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