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General NPI Number Information
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NPI Number | 1881881548
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Entity Type | Organization
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Legal Business Name | NASSAU SUFFOLK PODIATRY ASSOCIATES
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 73 HAMLET DR
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City | COMMACK
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State | NY
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Zip | 11725-4439
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Country | US
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Telephone | 631-858-0011
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Fax | 631-858-0011
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Provider Business Mailing Address
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Address Line | 1670 OLD COUNTRY RD SUITE 120B
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City | PLAINVIEW
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State | NY
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Zip | 11803-5000
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Country | US
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Telephone | 631-858-0011
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Fax | 631-858-0011
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SPENCER F. DUBOV
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Credential | D.P.M.
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Telephone | 631-858-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 002042
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License Number State | NY
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