Provider Demographics
NPI:1184687584
Name:SAKOWSKI, JONATHAN WHITNEY (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:WHITNEY
Last Name:SAKOWSKI
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 HOMEBASE LN
Mailing Address - Street 2:
Mailing Address - City:UNITYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17774-9070
Mailing Address - Country:US
Mailing Address - Phone:570-322-2251
Mailing Address - Fax:570-601-0133
Practice Address - Street 1:2605 REACH RD
Practice Address - Street 2:STE A
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-4181
Practice Address - Country:US
Practice Address - Phone:570-322-2251
Practice Address - Fax:570-322-2251
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009756L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3811086OtherAETNA
PA20-2108080OtherTRICARE
PA264602OtherHEALTH AMERICA PROVIDER #
PA50049989OtherCAPITIAL BLUE CROSS
PA1012131140001Medicaid
PA000360690OtherBC/BS NE PA PROVIDER #
PAP00213203OtherMEDICARE RAILROAD
PA819036OtherFIRST PRIORITY HEALTH
PAQ91591OtherAMERIHEALTH PROVIDER #
PA089722T3GMedicare ID - Type UnspecifiedIND. PROVIDER NUMBER