Healthcare Provider Details

I. General information

NPI: 1104428499
Provider Name (Legal Business Name): MICHAL DUBOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 RIVERSIDE DR STE 2
PINE BROOK NJ
07058-9391
US

IV. Provider business mailing address

18 WYNDHAM PL
ROBBINSVILLE NJ
08691-3121
US

V. Phone/Fax

Practice location:
  • Phone: 224-628-4001
  • Fax:
Mailing address:
  • Phone: 224-628-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number08787533
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number18-172
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberNJDCATEMP-001670
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2019028021
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberP129347
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: