MEDICARE: MRS. ROSEMARY ILGENFRITZ LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133N00000X	Nutritionist	DN001681	PA

General Provider Information

NPI Number	:	1700832821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSEMARY ILGENFRITZ LDN

Provider Business Mailing Address
First Line	:	1401 S 31ST ST FL 2
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19146-3506
Country	:	US
Telephone Number	:	215-925-2400
Fax Number	:	215-925-9162

Provider Business Practice Location Address
First Line	:	1401 S 31ST ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19146-3506
Country	:	US
Telephone Number	:	215-755-7700
Fax Number	:	215-755-3177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	04/21/2017

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