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General NPI Number Information
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NPI Number | 1093376808
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Entity Type | Individual
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Provider Name | JASON ROSENGARD PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/23/2019
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 212 CREEK CROSSING BLVD
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City | HAINESPORT
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State | NJ
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Zip | 08036-2766
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Country | US
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Telephone | 609-267-1004
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Fax |
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Provider Business Mailing Address
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Address Line | 7 CHELSEA CT
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City | MEDFORD
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State | NJ
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Zip | 08055-4039
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Country | US
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Telephone | 856-625-4916
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00528800
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License Number State | NJ
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