Healthcare Provider Details

I. General information

NPI: 1700832821
Provider Name (Legal Business Name): ROSEMARY ILGENFRITZ LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSEMARY PERNA LDN

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S 31ST ST
PHILA PA
19146-3506
US

IV. Provider business mailing address

1401 S 31ST ST FL 2
PHILA PA
19146-3506
US

V. Phone/Fax

Practice location:
  • Phone: 215-755-7700
  • Fax: 215-755-3177
Mailing address:
  • Phone: 215-925-2400
  • Fax: 215-925-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN001681
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: