MEDICARE: MS. JAMIE A RACKOFF APN

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
1	163W00000X	Registered Nurse	RN543343	PA
2	367A00000X	Advanced Practice Midwife	MW010124	PA
3	363LW0102X	Women's Health Nurse Practitioner	SP009288	PA
4	163W00000X	Registered Nurse	26NR11571700	NJ
5	363LW0102X	Women's Health Nurse Practitioner	26NJ00261400	NJ

General Provider Information

NPI Number	:	1437112760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAMIE A RACKOFF APN

Provider Business Mailing Address
First Line	:	4 ETHEL RD
Second Line	:	SUITE 402
City	:	EDISON
State	:	NJ
Zip	:	08817-2841
Country	:	US
Telephone Number	:	732-287-3643
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 ETHEL RD
Second Line	:	SUITE 402
City	:	EDISON
State	:	NJ
Zip	:	08817-2841
Country	:	US
Telephone Number	:	732-287-3643
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	10/08/2012

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