Active NPI
Bruce L Rebold, MD
- Gynecology Physician
- Syosset, NY
National Provider Identifier
1215089313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 136518
- Practice address
- 87 Cold Spring Rd
Syosset, NY 11791-3109 - Phone
- (516) 921-3168
- NPI assigned
- Jan 17, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 136518 | NY | Primary |
| Obstetrics Physician | 207VX0000X | 136518 | NY |
Addresses
Primary practice location
87 Cold Spring Rd
Syosset, NY 11791-3109
Mailing address
87 Cold Spring Rd
Syosset, NY 11791-3109
Phone (516) 921-3168
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 136518 | NY | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333584000000",
"number": "1215089313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "87 COLD SPRING RD",
"city": "SYOSSET",
"state": "NY",
"postal_code": "117913109",
"telephone_number": "516-921-3168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "87 COLD SPRING RD",
"city": "SYOSSET",
"state": "NY",
"postal_code": "117913109",
"telephone_number": "516-921-3168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REBOLD",
"first_name": "BRUCE",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-17",
"last_updated": "2012-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "NY",
"license": "136518",
"primary": true
},
{
"code": "207VX0000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Obstetrics",
"state": "NY",
"license": "136518",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syosset, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.