Provider Demographics
NPI:1184306664
Name:DESKO, CELENE ROSA
Entity type:Individual
Prefix:
First Name:CELENE
Middle Name:ROSA
Last Name:DESKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:PA
Mailing Address - Zip Code:18917-2200
Mailing Address - Country:US
Mailing Address - Phone:267-337-4559
Mailing Address - Fax:
Practice Address - Street 1:1255 S CEDAR CREST BLVD STE 2500
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6240
Practice Address - Country:US
Practice Address - Phone:610-770-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
PAMA065057363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant