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General NPI Number Information
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NPI Number | 1255859112
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Entity Type | Organization
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Legal Business Name | PENN'S ROCK PRIMARY CARE
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 801 WASHINGTON AVE UNIT C
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City | PHILADELPHIA
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State | PA
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Zip | 19147-4716
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Country | US
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Telephone | 267-519-9359
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Fax | 267-519-8120
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Provider Business Mailing Address
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Address Line | PO BOX 251
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-0251
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Country | US
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Telephone | 215-551-0200
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Fax | 215-551-0209
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MONIKA VANSANT
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Credential | DO
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Telephone | 267-519-9353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS010207L
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License Number State | PA
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