Individual
JACOB TYLER STANCATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 S CEDAR CREST BLVD, ALLENTOWN, PA 18103-6202
(610) 402-8000
Mailing address
2100 MACK BLVD FL 4, ALLENTOWN, PA 18103-5622
(484) 629-2282
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA063010
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA063010
STATE LICENSE
PA
Enumeration date
10/11/2021
Last updated
03/15/2022
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