Individual provider Active NPI

Michael J Ciskowski, PA-C

  • Physician Assistant
  • Wall Township, NJ
National Provider Identifier
1619996402
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00193800 Issued in NJ
Practice address
4810 Belmar Blvd
Wall Township, NJ 07753-6952
Phone
(732) 938-6090
Fax
(732) 938-5680
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001569 CT
Surgical Physician Assistant 363AS0400X 25MP00193800 NJ
Physician Assistant 363A00000X 25MP00193800 NJ Primary

Addresses

Primary practice location

4810 Belmar Blvd
Wall Township, NJ 07753-6952

Mailing address

2 Worlds Fair Dr
Somerset, NJ 08873-1369
Phone (732) 537-0909

Other practice location 1

110 Rehill Ave
Somerville, NJ 08876-2519
Phone (908) 685-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090819000460 NJ Practitioner - Physician Assistant 8426008814 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthonj LLCGroup PAC ID 6800225178, 302 clinicians

Practice addresses (Care Compare)

2315 Route 34
Manasquan, NJ 08736-1444
Phone (732) 974-0404

5 Plainsboro Rd
Plainsboro, NJ 08536-1915
Phone (609) 924-8131

Hospital & facility affiliations

  • Jersey Shore University Medical Center Hospital, Neptune, NJ, CCN 310073
  • Robert Wood Johnson University Hospital - Somerset Hospital, Somerville, NJ, CCN 310048

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
25MP00193800NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthonj LLC CurrentSince Sep 1, 2020 Accepting new patients
Orthonj LLC CurrentSince Sep 1, 2020 Accepting new patients
Barnabas Health Medical Group PC CurrentSince Jul 1, 2024 Accepting new patients
Barnabas Health Medical Group PC CurrentSince Jul 1, 2024 Accepting new patients

Locations

475 Route 70
Ste 101
Lakewood, NJ 08701
Phone (732) 364-8000

94 Old Short Hills Rd
Livingston, NJ 07039
Phone (973) 322-5400

2315 Route 34
Manasquan, NJ 08736
Phone (732) 974-0404

1 Rwj Pl
New Brunswick, NJ 08901
Phone (732) 235-7887

5 Plainsboro Rd
Ste 100
Plainsboro, NJ 08536
Phone (609) 750-1600

2 Worlds Fair Dr
Somerset, NJ 08873
Phone (732) 537-0200

110 Rehill Ave
Somerville, NJ 08876
Phone (908) 429-5833

4810 Belmar Blvd
Wall Township, NJ 07753
Phone (732) 938-5333

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1619996402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 WORLDS FAIR DR",
            "city": "SOMERSET",
            "state": "NJ",
            "postal_code": "088731369",
            "telephone_number": "732-537-0909",
            "fax_number": "732-564-9032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4810 BELMAR BLVD",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077536952",
            "telephone_number": "732-938-6090",
            "fax_number": "732-938-5680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Rehill Ave",
            "address_purpose": "LOCATION",
            "city": "Somerville",
            "state": "NJ",
            "postal_code": "088762519",
            "country_code": "US",
            "telephone_number": "908-685-2200",
            "fax_number": "732-923-2272",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CISKOWSKI",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "001569",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NJ",
            "license": "25MP00193800",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00193800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wall Township, NJ

Sources for this page

Verify at the official NPI Registry.