Provider Demographics
NPI:1417944034
Name:JASKI, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:JASKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:896 RIVERVIEW RD
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1318
Mailing Address - Country:US
Mailing Address - Phone:518-399-4600
Mailing Address - Fax:
Practice Address - Street 1:896 RIVERVIEW RD
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:NY
Practice Address - Zip Code:12148-1318
Practice Address - Country:US
Practice Address - Phone:518-399-4600
Practice Address - Fax:518-399-0286
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118189207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B80836Medicare UPIN
56918JMedicare PIN
900001753Medicare PIN
P00341096Medicare PIN