Provider Demographics
NPI:1033592142
Name:PAWLOWSKI, MEGAN (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PAWLOWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3548 ROUTE 9 STE 2
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2765
Mailing Address - Country:US
Mailing Address - Phone:732-679-6300
Mailing Address - Fax:
Practice Address - Street 1:3548 ROUTE 9
Practice Address - Street 2:SUITE 2
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2765
Practice Address - Country:US
Practice Address - Phone:732-679-6300
Practice Address - Fax:732-679-9566
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00370400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ475372YD00Medicare PIN
NJ475372MAGMedicare PIN