Healthcare Provider Details

I. General information

NPI: 1689103632
Provider Name (Legal Business Name): DANIELLE DUBOIS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 08/14/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BROADWAY
BROOKLYN NY
11206-5318
US

IV. Provider business mailing address

485 ATLANTIC AVE APT 3
BROOKLYN NY
11217-1890
US

V. Phone/Fax

Practice location:
  • Phone: 646-614-8327
  • Fax: 646-614-8327
Mailing address:
  • Phone: 401-824-6318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number007111
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: