Provider Demographics
NPI:1437112760
Name:RACKOFF, JAMIE A (APN)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:A
Last Name:RACKOFF
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ETHEL RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2841
Mailing Address - Country:US
Mailing Address - Phone:732-287-3643
Mailing Address - Fax:
Practice Address - Street 1:4 ETHEL RD
Practice Address - Street 2:SUITE 402
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2841
Practice Address - Country:US
Practice Address - Phone:732-287-3643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN543343163W00000X
PAMW010124367A00000X
PASP009288363LW0102X
NJ26NR11571700163W00000X
NJ26NJ00261400363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife