Healthcare Provider Details

I. General information

NPI: 1467345462
Provider Name (Legal Business Name): PATRICK JOHN ENSMENGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 KNIGHTS RD
PHILADELPHIA PA
19114-4200
US

IV. Provider business mailing address

7 BEATRICE LN
OLD BETHPAGE NY
11804-1001
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4000
  • Fax:
Mailing address:
  • Phone: 516-659-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA066681
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: