Individual provider Active NPI

Katherine Reinertsen-Rubin, N.P.

  • Nurse Practitioner
  • Northport, NY
National Provider Identifier
1063449015
Registry record updated Mar 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
304275 Issued in NY
Practice address
7 Oleander Dr
Northport, NY 11768-3438
Phone
(631) 235-3575
NPI assigned
Jun 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 304275 NY Primary

Addresses

Primary practice location

7 Oleander Dr
Northport, NY 11768-3438

Mailing address

353 Veterans Memorial Hwy
Suite 303
Commack, NY 11725-4200
Phone (631) 864-3900

Other identifiers 1

IdentifierTypeStateIssuer
02976396MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070529000448 NY Practitioner - Nurse Practitioner 7618074543 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
304275NYMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Rosalind and Joseph Gurwin Jewish Geriatric Center of Long Island CurrentSince May 1, 2013 Accepting new patients
The Rosalind and Joseph Gurwin Jewish Geriatric Center of Long Island CurrentSince May 1, 2013 Accepting new patients

Locations

68 Hauppauge Rd
Commack, NY 11725
Phone (631) 499-6500

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363219200000",
    "number": "1063449015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "353 VETERANS MEMORIAL HWY",
            "address_2": "SUITE 303",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117254200",
            "telephone_number": "631-864-3900",
            "fax_number": "631-864-2954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 OLEANDER DR",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117683438",
            "telephone_number": "631-235-3575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REINERTSEN-RUBIN",
        "first_name": "KATHERINE",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-26",
        "last_updated": "2013-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "304275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02976396",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northport, NY

Sources for this page

Verify at the official NPI Registry.