Provider Demographics
NPI:1194773440
Name:STRAKER, MICHAEL JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:STRAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:359 CENTRE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2791
Mailing Address - Country:US
Mailing Address - Phone:973-667-1500
Mailing Address - Fax:973-667-0324
Practice Address - Street 1:359 CENTRE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2791
Practice Address - Country:US
Practice Address - Phone:973-667-1500
Practice Address - Fax:973-667-0324
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07470800207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ128057Medicare PIN
NJ069666Medicare PIN