Provider Demographics
NPI:1609873231
Name:RAKLER, EDWARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:RAKLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1642
Mailing Address - Country:US
Mailing Address - Phone:908-994-1500
Mailing Address - Fax:908-994-0035
Practice Address - Street 1:500 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1642
Practice Address - Country:US
Practice Address - Phone:908-994-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00107900363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071939WJ8Medicare PIN
NJP94994Medicare UPIN
NJ071939Medicare ID - Type Unspecified