Provider Demographics
NPI:1114950177
Name:LASKO, RAYMOND JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JAMES
Last Name:LASKO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CREEK
Mailing Address - State:NJ
Mailing Address - Zip Code:08092-9321
Mailing Address - Country:US
Mailing Address - Phone:609-294-0350
Mailing Address - Fax:
Practice Address - Street 1:1700 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1253
Practice Address - Country:US
Practice Address - Phone:732-363-7900
Practice Address - Fax:732-363-9341
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2670111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ401352M5AMedicare ID - Type Unspecified
NJT73109Medicare UPIN