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General NPI Number Information
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NPI Number | 1508042771
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Entity Type | Organization
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Legal Business Name | JACK DUBIN
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Dates
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Enumeration Date | 01/17/2008
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 50 SUTTON PL S SOUTH 17F
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City | NEW YORK
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State | NY
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Zip | 10022-4167
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Country | US
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Telephone | 212-308-3002
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Fax | 212-308-3002
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Provider Business Mailing Address
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Address Line | 50 SUTTON PL S SOUTH 17F
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City | NEW YORK
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State | NY
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Zip | 10022-4167
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Country | US
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Telephone | 212-308-3002
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Fax | 212-308-3002
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Authorized Official
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Title or Position | SUPPLIER
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Name | DR. JACK DUBIN
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Credential | OD
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Telephone | 212-308-3002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | T001763-1
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License Number State | NY
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