Provider Demographics
NPI:1407846884
Name:DUBOV, GLENN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:ALAN
Last Name:DUBOV
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 1:8 OLD BRIDGE TPKE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08882-2400
Mailing Address - Country:US
Mailing Address - Phone:732-390-4888
Mailing Address - Fax:732-390-0255
Practice Address - Street 1:8 OLD BRIDGE TPKE
Practice Address - Street 2:
Practice Address - City:SOUTH RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08882-2400
Practice Address - Country:US
Practice Address - Phone:732-390-4888
Practice Address - Fax:732-390-0255
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ51482207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0323705Medicaid
A64361Medicare UPIN
DU137451Medicare ID - Type Unspecified