Healthcare Provider Details

I. General information

NPI: 1285630368
Provider Name (Legal Business Name): JAY J DUBOWSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 NORTHERN BLVD
MANHASSET NY
11030-3040
US

IV. Provider business mailing address

1155 NORTHERN BLVD
MANHASSET NY
11030-3040
US

V. Phone/Fax

Practice location:
  • Phone: 516-407-4000
  • Fax: 516-627-4208
Mailing address:
  • Phone: 516-407-4000
  • Fax: 516-627-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number199241
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number199241
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: