Provider Demographics
NPI:1639523046
Name:MASOTTI, JOCELYN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:ELIZABETH
Last Name:MASOTTI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JOCELYN
Other - Middle Name:ELIZABETH
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:564 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6108
Practice Address - Country:US
Practice Address - Phone:570-501-6400
Practice Address - Fax:570-453-2353
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058190363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103277110-0001Medicaid