Provider Demographics
NPI:1467704387
Name:DUBIN, ILANA BETH
Entity Type:Individual
Prefix:MRS
First Name:ILANA
Middle Name:BETH
Last Name:DUBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 BARNARD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2710
Mailing Address - Country:US
Mailing Address - Phone:516-792-1407
Mailing Address - Fax:
Practice Address - Street 1:588 BARNARD AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2710
Practice Address - Country:US
Practice Address - Phone:516-792-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1851947174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1851947OtherCERTIFICATION