1083632228 NPI number — DAVID H JAFFE MD

Table of content: DAVID H JAFFE MD (NPI 1083632228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083632228 NPI number — DAVID H JAFFE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAFFE
Provider First Name:
DAVID
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083632228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7365 MAIN ST
Provider Second Line Business Mailing Address:
BRIDGEPORT ANESTHESIA ASSOCIATES, P.C.
Provider Business Mailing Address City Name:
STRATFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06614-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-384-3174
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
267 GRANT ST
Provider Second Line Business Practice Location Address:
BRIDGEPORT ANESTHESIA ASSOCIATES, P.C.
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06610-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-384-3072
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  025274 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A770995 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 500HBA011CT01 . This is a "BCBS CT" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: P00126836 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060855634003 . This is a "CIGNA CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 755806 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CHN858 . This is a "COMMUNITY HEALTH NETWORK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4495952 . This is a "AETNA CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 95012 . This is a "HEALTH NET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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