Provider Demographics
NPI:1043478100
Name:ROZENCWAIG, HEATHER ANN (APN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:ROZENCWAIG
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N KINGS HIGHWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034
Mailing Address - Country:US
Mailing Address - Phone:856-602-4000
Mailing Address - Fax:856-842-5109
Practice Address - Street 1:200 BOWMAN DR
Practice Address - Street 2:SUITE D285
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-602-4000
Practice Address - Fax:856-947-1747
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009658363LF0000X
NJ26NJ00166100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103088516Medicaid
PA103088516Medicaid