Healthcare Provider Details

I. General information

NPI: 1992978514
Provider Name (Legal Business Name): ALBERT KOWALSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 LIVINGSTON AVE
ROSELAND NJ
07068-1733
US

IV. Provider business mailing address

48 HALLER DR
CEDAR GROVE NJ
07009-1705
US

V. Phone/Fax

Practice location:
  • Phone: 973-548-5189
  • Fax: 973-548-7690
Mailing address:
  • Phone: 973-239-1879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA03952300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: