Healthcare Provider Details

I. General information

NPI: 1538140959
Provider Name (Legal Business Name): JENNIFER M RUPPERSBERGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 FLORAL VALE BLVD
YARDLEY PA
19067-5515
US

IV. Provider business mailing address

903 FLORAL VALE BLVD
YARDLEY PA
19067-5515
US

V. Phone/Fax

Practice location:
  • Phone: 215-579-6155
  • Fax:
Mailing address:
  • Phone: 215-579-6155
  • Fax: 215-860-0723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA003105
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMA003105
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP3059562
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerOXFORD
# 2
Identifier9106916001
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCIGNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: