Provider Demographics
NPI:1972694800
Name:ROTHKOPF, JAY EVAN (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:EVAN
Last Name:ROTHKOPF
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 1:2500 MARYLAND RD
Mailing Address - Street 2:SUITE #400
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8302 OLD YORK RD
Practice Address - Street 2:BRIARHOUSE
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1522
Practice Address - Country:US
Practice Address - Phone:215-885-8550
Practice Address - Fax:215-885-8870
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429771208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106068Medicare PIN