Provider Demographics
NPI:1275587859
Name:DOMBROWSKI, JAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:DOMBROWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 647
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-486-0600
Mailing Address - Fax:585-486-0649
Practice Address - Street 1:125 RED CREEK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-486-0600
Practice Address - Fax:585-486-0649
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1902722085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01565562Medicaid
GA920006594OtherPALMETTO GBA-RAILROAD MC
GA920007535OtherPALMETTO GBA-RAILROAD MC
NY101432FEOtherPREFERRED CARE
NY4451073OtherAETNA
NYP010190272OtherBLUE CHOICE
NYP020190272OtherBLUE SHIELD
NYP010190272OtherBLUE SHIELD
NYF70150Medicare UPIN
GA920006594OtherPALMETTO GBA-RAILROAD MC
NYDD0394Medicare PIN