Healthcare Provider Details

I. General information

NPI: 1447792023
Provider Name (Legal Business Name): STEPHEN J ROSKOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 CORPORATE PKWY SUITE 130
CENTER VALLEY PA
18034-8230
US

IV. Provider business mailing address

3701 CORPORATE PKWY SUITE 130
CENTER VALLEY PA
18034-8230
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-7300
  • Fax: 610-791-3107
Mailing address:
  • Phone: 484-526-7300
  • Fax: 610-791-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP016776
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: