Provider Demographics
NPI:1407950082
Name:KAREL RASKA JR MD - MODERN DIAGNOSTICS
Entity Type:Organization
Organization Name:KAREL RASKA JR MD - MODERN DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREL
Authorized Official - Middle Name:
Authorized Official - Last Name:RASKA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:732-745-6677
Mailing Address - Street 1:PO BOX 1285
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1285
Mailing Address - Country:US
Mailing Address - Phone:732-246-1100
Mailing Address - Fax:
Practice Address - Street 1:254 EASTON AVENUE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08903-0591
Practice Address - Country:US
Practice Address - Phone:732-745-6677
Practice Address - Fax:732-828-3858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7362803Medicaid
NJ958076Medicare PIN