Provider Demographics
NPI:1073697330
Name:ROGASKI, KRISTA WARK (MS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:WARK
Last Name:ROGASKI
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:90 BERGEN ST # 8100
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2425
Mailing Address - Country:US
Mailing Address - Phone:973-972-2323
Mailing Address - Fax:
Practice Address - Street 1:90 BERGEN ST # 8100
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00163600363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical