Provider Demographics
NPI:1588677033
Name:RASIZER, DAVID L (PA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:RASIZER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:L
Other - Last Name:RASIZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 3295
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-3295
Mailing Address - Country:US
Mailing Address - Phone:973-902-2307
Mailing Address - Fax:862-221-9799
Practice Address - Street 1:12 PERERA AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4330
Practice Address - Country:US
Practice Address - Phone:973-902-2307
Practice Address - Fax:862-221-9799
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00025700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS47725Medicare UPIN