Healthcare Provider Details

I. General information

NPI: 1255460309
Provider Name (Legal Business Name): MICHAEL FRANCIS KOWALSKI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 HAMBURG TPKE STE 2A
POMPTON LAKES NJ
07442-2332
US

IV. Provider business mailing address

191 HAMBURG TPKE STE 2A
POMPTON LAKES NJ
07442-2332
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-3200
  • Fax: 973-839-3095
Mailing address:
  • Phone: 973-839-3200
  • Fax: 973-839-3095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD1838
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00183800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: