Provider Demographics
NPI:1073780540
Name:LEWIS M. DUBROFF, M.D.,P.C.
Entity Type:Organization
Organization Name:LEWIS M. DUBROFF, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUBROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:315-471-3384
Mailing Address - Street 1:475 IRVING AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1528
Mailing Address - Country:US
Mailing Address - Phone:315-471-3384
Mailing Address - Fax:
Practice Address - Street 1:475 IRVING AVE STE 314
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1528
Practice Address - Country:US
Practice Address - Phone:315-471-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131701207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00462675Medicaid
NY00462675Medicaid