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General NPI Number Information
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NPI Number | 1669764486
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Entity Type | Individual
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Provider Name | JOSHUA ALEXANDER ROLNICK
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Gender | Male
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 3900 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4551
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Country | US
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Telephone | 158-235-8002
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Fax |
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Provider Business Mailing Address
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Address Line | 423 GUARDIAN DR FL HALL13
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4865
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Country | US
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Telephone | 617-538-5191
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD459505
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License Number State | PA
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