Provider Demographics
NPI:1184514085
Name:DUBROV, ROMAN
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:DUBROV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 JFK PKWY FL 1
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2713
Mailing Address - Country:US
Mailing Address - Phone:917-582-6622
Mailing Address - Fax:
Practice Address - Street 1:51 JFK PKWY FL 1
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2713
Practice Address - Country:US
Practice Address - Phone:917-582-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF406837363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health