Individual
MR. JAY EDWARD ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
706 S 11TH ST, #3B, PHILADELPHIA, PA 19147-1968
(215) 913-7381
Mailing address
706 S 11TH ST, #3B, PHILADELPHIA, PA 19147-1968
(215) 913-7381
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP010741
PA
Other
Enumeration date
03/16/2010
Last updated
03/16/2010
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