Healthcare Provider Details

I. General information

NPI: 1841357191
Provider Name (Legal Business Name): ELYSSA K ROSENBERG PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21065 POWERLINE RD STE 2A
BOCA RATON FL
33433-2311
US

IV. Provider business mailing address

21065 POWERLINE RD STE 2A
BOCA RATON FL
33433-2311
US

V. Phone/Fax

Practice location:
  • Phone: 561-652-8654
  • Fax: 561-652-8655
Mailing address:
  • Phone: 561-652-8654
  • Fax: 561-652-8655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120467
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA052849
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: