Provider Demographics
NPI:1992978514
Name:KOWALSKI, ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:KOWALSKI
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 1:48 HALLER DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1705
Mailing Address - Country:US
Mailing Address - Phone:973-239-1879
Mailing Address - Fax:
Practice Address - Street 1:80 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1733
Practice Address - Country:US
Practice Address - Phone:973-548-5189
Practice Address - Fax:973-548-7690
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03952300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C52826Medicare UPIN