Healthcare Provider Details

I. General information

NPI: 1730498049
Provider Name (Legal Business Name): ALICIA ANN ROESLER MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA SCHUMAKER

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MADISON AVE FL 1
MOUNT HOLLY NJ
08060-2099
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 609-914-6000
  • Fax: 609-914-6182
Mailing address:
  • Phone: 609-914-6000
  • Fax: 609-914-6182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA054606
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00270700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number014246
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: