Provider Demographics
NPI:1922100130
Name:ROSBOROUGH, JENNIFER A (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:ROSBOROUGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1870
Mailing Address - Country:US
Mailing Address - Phone:856-461-1400
Mailing Address - Fax:856-461-2366
Practice Address - Street 1:8001 ROUTE 130
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-1870
Practice Address - Country:US
Practice Address - Phone:856-461-1400
Practice Address - Fax:856-461-2366
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00079700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
069316RGKMedicare ID - Type Unspecified
P46928Medicare UPIN