Individual provider Active NPI

Lise D Rubin, OTR/L

  • Occupational Therapist
  • New York, NY
National Provider Identifier
1902052764
Registry record updated Jan 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
001374 Issued in NY
Practice address
110 Bennett Ave
Apt. C
New York, NY 10033-2308
Phone
(312) 972-0109
NPI assigned
Aug 13, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT.006723 OH
Occupational Therapist 225X00000X 001374 NY Primary
Occupational Therapist 225X00000X AH 355 MA

Addresses

Primary practice location

110 Bennett Ave
Apt. C
New York, NY 10033-2308

Mailing address

110 Bennett Ave
Apt. C
New York, NY 10033-2308
Phone (312) 972-0109

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

State licenses

LicenseStateTypeSpecialty
AH 355MAMDOccupational Therapist
OT.006723OHMDOccupational Therapist
001374NYMDMedical Physician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325462400000",
    "number": "1902052764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BENNETT AVE",
            "address_2": "APT. C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100332308",
            "telephone_number": "312-972-0109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BENNETT AVE",
            "address_2": "APT. C",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100332308",
            "telephone_number": "312-972-0109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBIN",
        "first_name": "LISE",
        "middle_name": "D",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-13",
        "last_updated": "2012-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "OH",
            "license": "OT.006723",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "001374",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MA",
            "license": "AH 355",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.

Verify at the official NPI Registry.