Individual provider · NPI-1

Michael J Ciskowski, PA-C

Physician Assistant · Wall Township, NJ

NPI number1619996402
StatusActive
Last updated in NPPESJun 20, 2024

Details

NPI
1619996402
Entity type
Individual (NPI-1)
Name
Michael J Ciskowski
Credential
PA-C
Sex
Male
Sole proprietor
No
Enumeration date
Jul 19, 2006
Certification date
Jun 20, 2024
Last updated
Jun 20, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician Assistant25MP00193800NJYes
363A00000X Physician Assistant001569CT
363AS0400X Physician Assistant, Surgical25MP00193800NJ

Practice location

4810 Belmar Blvd
Wall Township, NJ 07753-6952

Phone 732-938-6090 · Fax 732-938-5680

Mailing address

2 Worlds Fair Dr
Somerset, NJ 08873-1369

Phone 732-537-0909 · Fax 732-564-9032

Other practice locations

110 Rehill Ave
Somerville, NJ 08876-2519

Phone 908-685-2200 · Fax 732-923-2272

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