Provider Demographics
NPI:1982881090
Name:LES JAY GLUBO D P M P C
Entity Type:Organization
Organization Name:LES JAY GLUBO D P M P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LES
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLUBO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-697-3293
Mailing Address - Street 1:122 E 42ND ST
Mailing Address - Street 2:2901
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 2:2901
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP39851Medicare PIN
NYT51216Medicare UPIN
NY5339380001Medicare NSC