Provider Demographics
NPI:1558455055
Name:ROSENBERGER, REBECCA (PAC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:ROSENBERGER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 APPLE ST
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-3209
Mailing Address - Country:US
Mailing Address - Phone:610-838-7096
Mailing Address - Fax:
Practice Address - Street 1:3445 HIGH POINT BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7809
Practice Address - Country:US
Practice Address - Phone:610-866-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00059700363A00000X
PAMA003152L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP37159Medicare UPIN