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General NPI Number Information
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NPI Number | 1861294332
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Entity Type | Individual
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Provider Name | JESSICA ROSE DEJNEKA
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Gender | Female
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 450 S EASTON RD
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City | GLENSIDE
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State | PA
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Zip | 19038-3295
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Country | US
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Telephone | 607-684-3030
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Fax |
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Provider Business Mailing Address
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Address Line | 3744 MANAYUNK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19128-3705
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Country | US
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Telephone | 607-684-3030
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA066761
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License Number State | PA
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