Provider Demographics
NPI:1265697528
Name:ROSZKOWSKI, JENNIFER R (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:ROSZKOWSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MEDICAL CENTER DR STE 205
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2358
Mailing Address - Country:US
Mailing Address - Phone:844-542-2273
Mailing Address - Fax:856-553-4390
Practice Address - Street 1:651 JOHN F KENNEDY WAY
Practice Address - Street 2:COOPER UNIVERSITY PHYSICIANS
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1262
Practice Address - Country:US
Practice Address - Phone:609-835-2838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015039207R00000X
NJ25MB09136800207R00000X
NJ320632207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0306134Medicaid
NJ244926ZGH1Medicare PIN