Provider Demographics
NPI:1841182516
Name:DIMATULAC, RUBENZON ABDON (RN)
Entity type:Individual
Prefix:MR
First Name:RUBENZON
Middle Name:ABDON
Last Name:DIMATULAC
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 BLEECKER ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1939
Mailing Address - Country:US
Mailing Address - Phone:718-644-9587
Mailing Address - Fax:
Practice Address - Street 1:2026 BLEECKER ST APT 1L
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1939
Practice Address - Country:US
Practice Address - Phone:718-644-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY583511163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse