Provider Demographics
NPI:1700046679
Name:RASKOVA, JANA (MD)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:RASKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2708
Mailing Address - Country:US
Mailing Address - Phone:732-846-1617
Mailing Address - Fax:732-828-2181
Practice Address - Street 1:400 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2708
Practice Address - Country:US
Practice Address - Phone:732-846-1617
Practice Address - Fax:732-828-2181
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MA 04118500207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1616307Medicaid
NJ1616307Medicaid