Provider Demographics
NPI:1447792023
Name:ROSKOS, STEPHEN J
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:ROSKOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 CORPORATE PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-8230
Mailing Address - Country:US
Mailing Address - Phone:484-526-7300
Mailing Address - Fax:610-791-3107
Practice Address - Street 1:3701 CORPORATE PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-8230
Practice Address - Country:US
Practice Address - Phone:484-526-7300
Practice Address - Fax:610-791-3107
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily