Provider Demographics
NPI:1578549549
Name:MILASK, TANYA (CRNA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:MILASK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 HUNTINGDON MEWS
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-5656
Mailing Address - Country:US
Mailing Address - Phone:856-296-1411
Mailing Address - Fax:
Practice Address - Street 1:435 HURFVILLE CROSS KEYS ROAD
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-582-2832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN318601L207L00000X, 367500000X
NJ26NO08774400367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50084188OtherCAPITAL BLEU CROSS
PA031898Q1RMedicare PIN
PA031898GDNMedicare PIN
PA50084188OtherCAPITAL BLEU CROSS
NJ232810A01Medicare PIN