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General NPI Number Information
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NPI Number | 1447905823
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Entity Type | Individual
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Provider Name | JENNA BEREZANSKY PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 693 MAIN ST BUILDING A STE 2
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City | LUMBERTON
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State | NJ
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Zip | 08048-5043
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Country | US
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Telephone | 609-265-1700
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Fax | 609-265-9005
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Provider Business Mailing Address
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Address Line | 301 LIPPINCOTT DR STE 410
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City | MARLTON
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State | NJ
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Zip | 08053-4197
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Country | US
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Telephone | 609-265-1700
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Fax | 609-265-8146
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00672700
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License Number State | NJ
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