Provider Demographics
NPI:1871069484
Name:RUBINO, CHRISTOPHER HART (RT (R), PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:HART
Last Name:RUBINO
Suffix:
Gender:M
Credentials:RT (R), PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SCUDDER AVE # 2E
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2915
Mailing Address - Country:US
Mailing Address - Phone:631-987-0175
Mailing Address - Fax:
Practice Address - Street 1:200 BELLE TERRE RD # 474-6000
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1968
Practice Address - Country:US
Practice Address - Phone:631-474-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022771-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical