Provider Demographics
NPI:1659658508
Name:RENITSKY, ASHLEIGH (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:
Last Name:RENITSKY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1250 S CEDAR CREST BLVD
Practice Address - Street 2:STE 210
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6224
Practice Address - Country:US
Practice Address - Phone:610-402-6986
Practice Address - Fax:610-402-1682
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055316363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical