Provider Demographics
NPI:1851542773
Name:GOLUBIEWSKI, MICHAEL THOMAS
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:GOLUBIEWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 LACEY ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759
Mailing Address - Country:US
Mailing Address - Phone:732-350-0022
Mailing Address - Fax:732-849-0022
Practice Address - Street 1:70 LACEY ROAD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759
Practice Address - Country:US
Practice Address - Phone:732-350-0022
Practice Address - Fax:732-849-0022
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00104000156FX1800X
NJMG60000689332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No332S00000XSuppliersHearing Aid Equipment