Provider Demographics
NPI:1932127719
Name:PETRASKE, ALISON R (MD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:R
Last Name:PETRASKE
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 1:5 PLAINSBORO RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536
Mailing Address - Country:US
Mailing Address - Phone:609-936-0700
Mailing Address - Fax:609-936-0750
Practice Address - Street 1:5 PLAINSBORO RD
Practice Address - Street 2:SUITE 500
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536
Practice Address - Country:US
Practice Address - Phone:609-936-0700
Practice Address - Fax:609-936-0750
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA065637207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D55453Medicare UPIN
953049Medicare ID - Type Unspecified