Provider Demographics
NPI:1194935122
Name:DUBOW, JORDAN S (MD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:S
Last Name:DUBOW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:CBO - 3RD FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3973
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:257 LAFAYETTE AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4830
Practice Address - Country:US
Practice Address - Phone:845-368-8808
Practice Address - Fax:845-368-5608
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2010-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-1181222084N0400X
NY2553452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY255345OtherNY LICENSE #
IL036-118122OtherIL STATE LIC