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Individual

DR. SPENCER F. DUBOV

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
73 HAMLET DR, COMMACK, NY 11725-4439
(631) 858-0011
(631) 858-0011
Mailing address
73 HAMLET DR, COMMACK, NY 11725-4439
(631) 858-0011
(631) 858-0011

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
002042
NY
213ES0131X
Foot Surgery Podiatrist
Primary
002042
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00414388
NY
01
P10342
BLUE SHIELD/BLUE CROSS
NY
Enumeration date
07/07/2005
Last updated
12/19/2007
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