Provider Demographics
NPI:1013196005
Name:SPENCER F. DUBOV, D.P.M., P.C.
Entity Type:Organization
Organization Name:SPENCER F. DUBOV, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:F
Authorized Official - Last Name:DUBOV
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-858-0011
Mailing Address - Street 1:73 HAMLET DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4439
Mailing Address - Country:US
Mailing Address - Phone:631-858-0011
Mailing Address - Fax:631-858-0011
Practice Address - Street 1:4295 HEMPSTEAD TPKE
Practice Address - Street 2:NEW ISLAND HOSPITAL/PHYSICIANS OFFICE
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5713
Practice Address - Country:US
Practice Address - Phone:631-858-0011
Practice Address - Fax:516-579-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002042213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT31780Medicare UPIN