Provider Demographics
NPI:1538485289
Name:ROSEFSKY, JONATHAN BENENSOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BENENSOHN
Last Name:ROSEFSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1951
Mailing Address - Country:US
Mailing Address - Phone:610-520-4595
Mailing Address - Fax:610-520-4595
Practice Address - Street 1:1164 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1951
Practice Address - Country:US
Practice Address - Phone:610-520-4595
Practice Address - Fax:610-520-4595
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010749 E208000000X
VA0101019529208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics