Healthcare Provider Details

I. General information

NPI: 1689771784
Provider Name (Legal Business Name): DAVID A LASKOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PLUM STREET 7TH FLOOR
NEW BRUNSWICK NJ
08901
US

IV. Provider business mailing address

120 ALBANY STREET TOWER 2, 7TH FLOOR
NEW BRUNSWICK NJ
08901-2126
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-8695
  • Fax: 732-235-8696
Mailing address:
  • Phone: 732-937-8537
  • Fax: 732-937-8941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA68436
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: