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NPI Code Detail

MEDICARE: MR. EDWARD RAKLER PA-C

MEDICARE: MR. EDWARD RAKLER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant25MP00107900NJ
2363A00000XPhysician Assistant25MP00107900NJ

General Provider Information

NPI Number : 1609873231
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDWARD RAKLER PA-C
Provider Business Mailing Address
First Line : 500 WESTFIELD AVE
Second Line :
City : ELIZABETH
State : NJ
Zip : 07208-1642
Country : US
Telephone Number : 908-994-1500
Fax Number : 908-994-0035
Provider Business Practice Location Address
First Line : 500 WESTFIELD AVE
Second Line :
City : ELIZABETH
State : NJ
Zip : 07208-1642
Country : US
Telephone Number : 908-994-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 12/15/2010

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Directions to “ MR. EDWARD RAKLER PA-C” Practice Location

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