Provider Demographics
NPI:1235163700
Name:ROTHBERG, JAY SEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:SEAN
Last Name:ROTHBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 LANGHORNE NEWTOWN RD
Mailing Address - Street 2:#225, ST CLARE BLDG
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1209
Mailing Address - Country:US
Mailing Address - Phone:215-750-7771
Mailing Address - Fax:215-750-6935
Practice Address - Street 1:540 WOODBOURNE RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1835
Practice Address - Country:US
Practice Address - Phone:215-750-7771
Practice Address - Fax:215-750-6935
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051142L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA463810OtherAETNA
PA0016328800003Medicaid
PA1054837OtherKEYSTONE/MERCY
PA632826OtherBLUE CROSS/BLUE SHIELD
PA0230832000OtherKEYSTONE HEALTH PLAN EAST
PA632826OtherBLUE CROSS/BLUE SHIELD
PA0230832000OtherKEYSTONE HEALTH PLAN EAST