Healthcare Provider Details

I. General information

NPI: 1407950082
Provider Name (Legal Business Name): KAREL RASKA JR MD - MODERN DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVENUE
NEW BRUNSWICK NJ
08903-0591
US

IV. Provider business mailing address

PO BOX 1285
HIGHLAND PARK NJ
08904-1285
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-6677
  • Fax: 732-828-3858
Mailing address:
  • Phone: 732-246-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREL RASKA JR.
Title or Position: OWNER
Credential: MD PHD
Phone: 732-745-6677