Provider Demographics
NPI:1407800147
Name:DUBROFF, JEROME M (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:M
Last Name:DUBROFF
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:PO BOX 6540
Mailing Address - Street 2:CHURCH STREET STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10249-6540
Mailing Address - Country:US
Mailing Address - Phone:718-946-7557
Mailing Address - Fax:718-946-9680
Practice Address - Street 1:130 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8002
Practice Address - Country:US
Practice Address - Phone:718-946-7557
Practice Address - Fax:718-946-9680
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141454207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00687710Medicaid
NY50A771Medicare PIN
B15545Medicare UPIN