Provider Demographics
NPI:1952438715
Name:DUBROFF, LEWIS M (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:M
Last Name:DUBROFF
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1756
Mailing Address - Country:US
Mailing Address - Phone:315-471-3384
Mailing Address - Fax:315-471-3394
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:SUITE 314
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1756
Practice Address - Country:US
Practice Address - Phone:315-471-3384
Practice Address - Fax:315-471-3394
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131701207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00462675Medicaid
NY39130BMedicare ID - Type UnspecifiedPROVIDER NUMBER
NY00462675Medicaid