Provider Demographics
NPI:1205839370
Name:DUBIN, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:DUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BROAD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2178
Mailing Address - Country:US
Mailing Address - Phone:315-363-5421
Mailing Address - Fax:315-363-5472
Practice Address - Street 1:221 BROAD ST STE 201
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2178
Practice Address - Country:US
Practice Address - Phone:315-363-5421
Practice Address - Fax:315-363-5472
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177764207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02116434Medicaid
NYJ400094458Medicare PIN