Healthcare Provider Details

I. General information

NPI: 1508052622
Provider Name (Legal Business Name): SPENCER F. DUBOV, D.P.M., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 HAMLET DR
COMMACK NY
11725-4439
US

IV. Provider business mailing address

73 HAMLET DR
COMMACK NY
11725-4439
US

V. Phone/Fax

Practice location:
  • Phone: 631-858-0011
  • Fax: 631-858-0011
Mailing address:
  • Phone: 631-858-0011
  • Fax: 631-858-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number002042
License Number StateNY

VIII. Authorized Official

Name: DR. SPENCER F. DUBOV
Title or Position: OWNER/PRESIDENT
Credential: D.P.M.
Phone: 631-858-0011