Provider Demographics
NPI:1700832821
Name:ILGENFRITZ, ROSEMARY (LDN)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:
Last Name:ILGENFRITZ
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:MISS
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:PERNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDN
Mailing Address - Street 1:1401 S 31ST ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-3506
Mailing Address - Country:US
Mailing Address - Phone:215-925-2400
Mailing Address - Fax:215-925-9162
Practice Address - Street 1:1401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19146-3506
Practice Address - Country:US
Practice Address - Phone:215-755-7700
Practice Address - Fax:215-755-3177
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001681133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist