Provider Demographics
NPI:1932251113
Name:ROSEN-PRIES, JESSICA AIMEE (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:AIMEE
Last Name:ROSEN-PRIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19723-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4000
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:110 WEST LANCASTER AVENUE, SUITE 200
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-4061
Practice Address - Country:US
Practice Address - Phone:610-293-2229
Practice Address - Fax:610-293-2231
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235921208000000X
PAMD436336208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics