Basic Information
| Provider Information | |||||||||
| NPI: | 1134501406 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSSOWSKI | ||||||||
| FirstName: | AUDREY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 GRIST MILL RD | ||||||||
| Address2: | |||||||||
| City: | OREFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180692310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107998202 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5501 OLD YORK RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191413018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154569850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2015 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | OT016781 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084P0804X | OS019066 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.