Healthcare Provider Details

I. General information

NPI: 1881520518
Provider Name (Legal Business Name): ANDREY DOUBOVIK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 DERBY AVE
ORANGE CT
06477-1345
US

IV. Provider business mailing address

329 DERBY AVE
ORANGE CT
06477-1345
US

V. Phone/Fax

Practice location:
  • Phone: 917-538-7833
  • Fax:
Mailing address:
  • Phone: 917-538-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.088618
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: