Provider Demographics
NPI:1720072606
Name:GLUBO, LES JAY (D P M)
Entity Type:Individual
Prefix:DR
First Name:LES
Middle Name:JAY
Last Name:GLUBO
Suffix:
Gender:M
Credentials:D P M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E 42ND ST
Mailing Address - Street 2:SUITE # 2901
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10168-0002
Mailing Address - Country:US
Mailing Address - Phone:212-697-3293
Mailing Address - Fax:212-949-7579
Practice Address - Street 1:122 E 42ND ST
Practice Address - Street 2:SUITE # 2901
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10168-0002
Practice Address - Country:US
Practice Address - Phone:212-697-3293
Practice Address - Fax:212-949-7579
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003241213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51216Medicare UPIN
NY5339380001Medicare NSC
NYP39851Medicare PIN