Healthcare Provider Details

I. General information

NPI: 1164410643
Provider Name (Legal Business Name): MARTIN P MICHALEWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 01/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SUNSET AVE
ASBURY PARK NJ
07712
US

IV. Provider business mailing address

1814 GREENWOOD TER
BELMAR NJ
07719-2912
US

V. Phone/Fax

Practice location:
  • Phone: 732-775-7978
  • Fax:
Mailing address:
  • Phone: 732-775-7978
  • Fax: 732-988-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME91461
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME91461
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA08681200
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number25MA08681200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: