Active NPI
Jordan S. Dubow, MD
- Neurology Physician
- Suffern, NY
National Provider Identifier
1194935122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 255345
- Practice address
- 257 Lafayette Ave
Suite 330
Suffern, NY 10901-4830 - Phone
- (845) 368-8808
- Fax
- (845) 368-5608
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 036-118122 | IL | |
| Neurology Physician | 2084N0400X | 255345 | NY | Primary |
Addresses
Primary practice location
257 Lafayette Ave
Suite 330
Suffern, NY 10901-4830
Mailing address
20 Grand St
Cbo - 3Rd Floor
Warwick, NY 10990-1035
Phone (845) 987-3973
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 255345 | Other | NY | NY LICENSE # |
| 036-118122 | Other | IL | IL STATE LIC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-118122 | IL | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bonaventure Medical Foundation, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Alexian Brothers Medical Foundation
- Family Medicine Physician
- Elk Grove Village, IL
- NPI 1588775647
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273622400000",
"number": "1194935122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 GRAND ST",
"address_2": "CBO - 3RD FLOOR",
"city": "WARWICK",
"state": "NY",
"postal_code": "109901035",
"telephone_number": "845-987-3973",
"fax_number": "845-987-5979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "257 LAFAYETTE AVE",
"address_2": "SUITE 330",
"city": "SUFFERN",
"state": "NY",
"postal_code": "109014830",
"telephone_number": "845-368-8808",
"fax_number": "845-368-5608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUBOW",
"first_name": "JORDAN",
"middle_name": "S.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2010-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "IL",
"license": "036-118122",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NY",
"license": "255345",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NY LICENSE #",
"identifier": "255345",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IL STATE LIC",
"identifier": "036-118122",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Suffern, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.