Basic Information
Provider Information
NPI: 1629289277
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUBE
FirstName: NITI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 800 WESTCHESTER AVE STE N715
Address2:  
City: RYE BROOK
State: NY
PostalCode: 105731369
CountryCode: US
TelephoneNumber: 9146075730
FaxNumber: 9144571195
Practice Location
Address1: 1 THEALL RD
Address2:  
City: RYE
State: NY
PostalCode: 105801404
CountryCode: US
TelephoneNumber: 9148488950
FaxNumber: 9148488951
Other Information
ProviderEnumerationDate: 05/25/2007
LastUpdateDate: 02/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/22/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001X229303NYY Allopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

No ID Information.


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