Provider Demographics
NPI:1366417115
Name:ROZANSKI, JENNIFER M (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:ROZANSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N 17TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5044
Mailing Address - Country:US
Mailing Address - Phone:610-434-4760
Mailing Address - Fax:610-820-9122
Practice Address - Street 1:501 N 17TH ST
Practice Address - Street 2:SUITE #108
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5044
Practice Address - Country:US
Practice Address - Phone:610-434-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010466L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA047037Medicare PIN
PAH34613Medicare UPIN