Healthcare Provider Details

I. General information

NPI: 1679930994
Provider Name (Legal Business Name): PAUL MARKOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2016
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE
SUMMIT NJ
07901
US

IV. Provider business mailing address

77 BRANT AVE STE 200
CLARK NJ
07066-1540
US

V. Phone/Fax

Practice location:
  • Phone: 908-608-0078
  • Fax:
Mailing address:
  • Phone: 732-382-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA10260300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: