1265697528 NPI number — JENNIFER R. ROSZKOWSKI DO

Table of content: DR. J H HERSHEY M.D., M.P.H. (NPI 1538141338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265697528 NPI number — JENNIFER R. ROSZKOWSKI DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSZKOWSKI
Provider First Name:
JENNIFER
Provider Middle Name:
R.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265697528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 MEDICAL CENTER DR STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08080-2358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-542-2273
Provider Business Mailing Address Fax Number:
856-553-4390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
651 JOHN F KENNEDY WAY
Provider Second Line Business Practice Location Address:
COOPER UNIVERSITY PHYSICIANS
Provider Business Practice Location Address City Name:
WILLINGBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08046-1262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-835-2838
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OS015039 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 25MB09136800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X , with the licence number: 320632 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0306134 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".