Healthcare Provider Details

I. General information

NPI: 1710511654
Provider Name (Legal Business Name): KELSEY OSOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2020
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 COOPER RD STE 16
VOORHEES NJ
08043-8007
US

IV. Provider business mailing address

4170 CITY AVE
PHILADELPHIA PA
19131-1610
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-2224
  • Fax: 856-429-1926
Mailing address:
  • Phone: 215-871-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00594000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: