Healthcare Provider Details

I. General information

NPI: 1346333564
Provider Name (Legal Business Name): MICHAEL DUBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 ROUTE 52
CARMEL NY
10512-1200
US

IV. Provider business mailing address

1351 ROUTE 55 STE 200
LAGRANGEVILLE NY
12540-5128
US

V. Phone/Fax

Practice location:
  • Phone: 845-228-2910
  • Fax: 845-228-2914
Mailing address:
  • Phone: 845-475-9661
  • Fax: 845-475-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number208056
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: