Provider Demographics
NPI:1932113636
Name:DUBOIS, NICHOLAS BROOKS (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BROOKS
Last Name:DUBOIS
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 1:177 EAST 87TH STREET
Mailing Address - Street 2:SUITE 507
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2005
Mailing Address - Country:US
Mailing Address - Phone:212-828-3200
Mailing Address - Fax:212-828-3240
Practice Address - Street 1:177 EAST 87TH STREET
Practice Address - Street 2:SUITE 507
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2005
Practice Address - Country:US
Practice Address - Phone:212-828-3200
Practice Address - Fax:212-828-3240
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223514207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2520288OtherUNITED HEALTHCARE
7430617OtherAETNA PPO
645Q11OtherEMPIRE BC/BS
P3597897OtherOXFORD
3765994OtherAETNA HMO
4C9293OtherHEALTHNET
4C9293OtherHEALTHNET
NY628P41Medicare ID - Type Unspecified