Individual
MR. JAN WARREN PIENCENAVES JALOSJOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5501 OLD YORK RD, PHILADELPHIA, PA 19141-3018
(215) 456-7900
Mailing address
304 CHESTNUT AVENUE, WOODLYNNE, NJ 08107
(267) 307-5795
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA052733
PA
363AM0700X
Medical Physician Assistant
MA052733
PA
363AM0700X
Medical Physician Assistant
OA002134
PA
363AS0400X
Surgical Physician Assistant
Primary
MA052733
PA
363AS0400X
Surgical Physician Assistant
OA002134
PA
Other
Enumeration date
05/14/2007
Last updated
02/09/2022
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