Healthcare Provider Details

I. General information

NPI: 1972694800
Provider Name (Legal Business Name): JAY EVAN ROTHKOPF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8302 OLD YORK RD BRIARHOUSE
ELKINS PARK PA
19027-1522
US

IV. Provider business mailing address

2500 MARYLAND RD SUITE #400
WILLOW GROVE PA
19090-1216
US

V. Phone/Fax

Practice location:
  • Phone: 215-885-8550
  • Fax: 215-885-8870
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD429771
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD429771
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: