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Individual

JORDAN S. DUBOW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
257 LAFAYETTE AVE, SUITE 330, SUFFERN, NY 10901-4830
(845) 368-8808
(845) 368-5608
Mailing address
20 GRAND ST, CBO - 3RD FLOOR, WARWICK, NY 10990-1035
(845) 987-3973
(845) 987-5979

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
036-118122
IL
2084N0400X
Neurology Physician
Primary
255345
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
036-118122
IL STATE LIC
IL
01
255345
NY LICENSE #
NY
Enumeration date
05/22/2007
Last updated
05/12/2010
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