Healthcare Provider Details

I. General information

NPI: 1356020630
Provider Name (Legal Business Name): EMILEE WASILEWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GREENTREE CENTER, SUITE 117
MARLTON NJ
08053-3422
US

IV. Provider business mailing address

148 CHESTNUT ST
KULPMONT PA
17834-1404
US

V. Phone/Fax

Practice location:
  • Phone: 609-474-0106
  • Fax:
Mailing address:
  • Phone: 570-985-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: