Provider Demographics
NPI:1699287375
Name:ROCKOVITS, JACOB WILLIAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:WILLIAM
Last Name:ROCKOVITS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:135 LAFAYETTE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1518
Mailing Address - Country:US
Mailing Address - Phone:610-824-8350
Mailing Address - Fax:610-824-8350
Practice Address - Street 1:135 LAFAYETTE AVE FL 2
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1518
Practice Address - Country:US
Practice Address - Phone:610-824-8350
Practice Address - Fax:610-824-8350
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059466363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical