Provider Demographics
NPI:1104428499
Name:DUBOWSKI, MICHAL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAL
Middle Name:
Last Name:DUBOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WYNDHAM PL
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-3121
Mailing Address - Country:US
Mailing Address - Phone:224-628-4001
Mailing Address - Fax:
Practice Address - Street 1:25 RIVERSIDE DR STE 2
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9391
Practice Address - Country:US
Practice Address - Phone:224-628-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA08787533207Q00000X
WI18-172246ZC0007X
NJNJDCATEMP-001670363A00000X
MO2019028021363A00000X
NYP129347208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant