Healthcare Provider Details

I. General information

NPI: 1790643559
Provider Name (Legal Business Name): JENNA PATHAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD STE 1070
NEWARK DE
19718-2200
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD STE 1070
NEWARK DE
19718-2200
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1663
  • Fax: 302-733-1616
Mailing address:
  • Phone: 302-733-1663
  • Fax: 302-733-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012429
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: