Healthcare Provider Details

I. General information

NPI: 1700521218
Provider Name (Legal Business Name): KERIN ROSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 10/07/2022
Certification Date: 08/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 E WOODLAND AVE STE 200
SPRINGFIELD PA
19064-3956
US

IV. Provider business mailing address

2201 CHESTNUT ST APT 203
PHILADELPHIA PA
19103-3049
US

V. Phone/Fax

Practice location:
  • Phone: 610-690-4490
  • Fax:
Mailing address:
  • Phone: 845-706-8312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT021491
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1700521218
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: