Basic Information
| Provider Information | |||||||||
| NPI: | 1144618240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOMBROSKI | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | PA-C, MPAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11050 MOUNT BELVEDERE BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT DRUM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136025438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157722778 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9559 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | BEAVER FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153466824 | ||||||||
| FaxNumber: | 3153466868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 1123032 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 020406 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.