MEDICARE: DR. JESSICA AIMEE ROSEN-PRIES MD

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	208000000X	Pediatrics Physician	235921	NY
2	208D00000X	General Practice Physician	MD436336	PA
3	208000000X	Pediatrics Physician	MD436336	PA

General Provider Information

NPI Number	:	1932251113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA AIMEE ROSEN-PRIES MD

Provider Business Mailing Address
First Line	:	P.O. BOX 191
Second Line	:
City	:	ROCKLAND
State	:	DE
Zip	:	19723-0191
Country	:	US
Telephone Number	:	302-651-4000
Fax Number	:	302-651-4945

Provider Business Practice Location Address
First Line	:	110 WEST LANCASTER AVENUE, SUITE 200
Second Line	:
City	:	WAYNE
State	:	PA
Zip	:	19087-4061
Country	:	US
Telephone Number	:	610-293-2229
Fax Number	:	610-293-2231

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	01/28/2016

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