Provider Demographics
NPI:1144763376
Name:RASLJANIN, SERVIJE
Entity Type:Individual
Prefix:
First Name:SERVIJE
Middle Name:
Last Name:RASLJANIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 HUDSON TER APT 2L
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3505
Mailing Address - Country:US
Mailing Address - Phone:646-207-3479
Mailing Address - Fax:
Practice Address - Street 1:2400 HUDSON TER APT 2L
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3505
Practice Address - Country:US
Practice Address - Phone:646-207-3479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-20
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267028-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse