Provider Demographics
NPI:1477711646
Name:DOMBROWSKI, WEN CHANG (MD)
Entity Type:Individual
Prefix:DR
First Name:WEN
Middle Name:CHANG
Last Name:DOMBROWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BROADWAY RM 200
Mailing Address - Street 2:MJHS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-3039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6323 7TH AVE
Practice Address - Street 2:MJHS MEDICAL ASSOCIATES
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4743
Practice Address - Country:US
Practice Address - Phone:212-649-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241741207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03257572Medicaid