Healthcare Provider Details

I. General information

NPI: 1598003501
Provider Name (Legal Business Name): ASHLEIGH KRISTEN RIEPEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVE SUITE 245
MOORESTOWN NJ
08057-3130
US

IV. Provider business mailing address

4 EVES DR # A SUITE 100
MARLTON NJ
08053-3195
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-9400
  • Fax: 609-267-9457
Mailing address:
  • Phone: 609-267-9400
  • Fax: 609-267-9457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: