Provider Demographics
NPI:1194048595
Name:DUBON, NEIL CHRISTOPHER (RPH)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:CHRISTOPHER
Last Name:DUBON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-4511
Mailing Address - Country:US
Mailing Address - Phone:516-270-3965
Mailing Address - Fax:516-502-6238
Practice Address - Street 1:601 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-4511
Practice Address - Country:US
Practice Address - Phone:516-270-3965
Practice Address - Fax:516-502-6238
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02808919Medicaid
5744580001Medicare NSC