Provider Demographics
NPI:1689771784
Name:LASKOW, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:LASKOW
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 1:120 ALBANY STREET
Mailing Address - Street 2:TOWER 2, 7TH FLOOR
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2126
Mailing Address - Country:US
Mailing Address - Phone:732-937-8537
Mailing Address - Fax:732-937-8941
Practice Address - Street 1:10 PLUM STREET
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-235-8695
Practice Address - Fax:732-235-8696
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68436174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6613403Medicaid
NJ6613403Medicaid
NJ024464Medicare ID - Type Unspecified