Healthcare Provider Details

I. General information

NPI: 1952508087
Provider Name (Legal Business Name): MICHAEL CRAIG DOBROW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 09/27/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 CLIFTON AVE # 1
CLIFTON NJ
07013-3622
US

IV. Provider business mailing address

1136 CLIFTON AVE # 1
CLIFTON NJ
07013-3622
US

V. Phone/Fax

Practice location:
  • Phone: 908-415-9319
  • Fax:
Mailing address:
  • Phone: 973-470-8848
  • Fax: 973-470-8826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MB08234500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB08234500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: