Provider Demographics
NPI:1669460705
Name:ROZANSKI, RAYMOND (PA)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:ROZANSKI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MARTER AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3124
Mailing Address - Country:US
Mailing Address - Phone:856-727-1000
Mailing Address - Fax:856-727-1000
Practice Address - Street 1:110 MARTER AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3124
Practice Address - Country:US
Practice Address - Phone:856-727-1000
Practice Address - Fax:856-727-1000
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00035300363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077551V9TMedicare PIN
NJP64956Medicare UPIN