Individual
JASON ROSENGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
212 CREEK CROSSING BLVD, HAINESPORT, NJ 08036-2766
(609) 267-1004
Mailing address
7 CHELSEA CT, MEDFORD, NJ 08055-4039
(856) 625-4916
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
25MP00528800
NJ
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0692069
—
NJ
Enumeration date
06/23/2019
Last updated
10/25/2024
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