Basic Information
| Provider Information | |||||||||
| NPI: | 1275587859 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOMBROWSKI | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | BOX 647 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146420001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854860600 | ||||||||
| FaxNumber: | 5854860649 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 RED CREEK DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854860600 | ||||||||
| FaxNumber: | 5854860649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 05/10/2013 | ||||||||
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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 | 2085R0001X | 190272 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | P020190272 | 01 | NY | BLUE SHIELD | OTHER | 01565562 | 05 | NY | MEDICAID | 101432FE | 01 | NY | PREFERRED CARE | OTHER | P010190272 | 01 | NY | BLUE CHOICE | OTHER | P010190272 | 01 | NY | BLUE SHIELD | OTHER | 920006594 | 01 | GA | PALMETTO GBA-RAILROAD MC | OTHER | 4451073 | 01 | NY | AETNA | OTHER | 920007535 | 01 | GA | PALMETTO GBA-RAILROAD MC | OTHER |