Healthcare Provider Details

I. General information

NPI: 1568211399
Provider Name (Legal Business Name): JEFFREY JOHN PODLASKOWICH DNAP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 03/02/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

11 CORNWALLIS RD
TOMS RIVER NJ
08755-1702
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2000
  • Fax: 201-487-0944
Mailing address:
  • Phone: 848-210-7347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ15149800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: