Provider Demographics
NPI:1891753851
Name:DOBKOWSKI, DARLENE LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:LYNN
Last Name:DOBKOWSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:LYNN
Other - Last Name:FALTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1680 ROUTE 23
Mailing Address - Street 2:STE 250
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7520
Mailing Address - Country:US
Mailing Address - Phone:973-633-1122
Mailing Address - Fax:973-633-9922
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:UROLOGY ONCOLOGY
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:201-541-5960
Practice Address - Fax:201-541-5988
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00124800363A00000X
NJ25MP000124800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ21432Medicare UPIN