Provider Demographics
NPI:1144618240
Name:DOMBROSKI, GREGORY MICHAEL (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MICHAEL
Last Name:DOMBROSKI
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 MOUNT BELVEDERE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13602-5438
Mailing Address - Country:US
Mailing Address - Phone:315-772-2778
Mailing Address - Fax:
Practice Address - Street 1:9559 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:NY
Practice Address - Zip Code:13305
Practice Address - Country:US
Practice Address - Phone:315-346-6824
Practice Address - Fax:315-346-6868
Is Sole Proprietor?:No
Enumeration Date:2014-12-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1123032363AM0700X
NY020406363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical