1174507529 NPI number — KENNETH SCOTT JAFFE M.D.

Table of content: KENNETH SCOTT JAFFE M.D. (NPI 1174507529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174507529 NPI number — KENNETH SCOTT JAFFE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAFFE
Provider First Name:
KENNETH
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1174507529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 JOHN F KENNEDY DR
Provider Second Line Business Mailing Address:
SUITE 134
Provider Business Mailing Address City Name:
ATLANTIS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33462-1141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-439-0308
Provider Business Mailing Address Fax Number:
561-328-6776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 JOHN F KENNEDY DR
Provider Second Line Business Practice Location Address:
SUITE 134
Provider Business Practice Location Address City Name:
ATLANTIS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33462-1141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-439-0308
Provider Business Practice Location Address Fax Number:
561-328-6776
Provider Enumeration Date:
11/30/2005

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: 207RG0300X , with the licence number:  ME78885 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2423088 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2165459 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: H04908 . This is a "VISTA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 002008791-002 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1023545 . This is a "PHCS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2509859 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 651050544 . This is a "HEALTH CARE DISTRIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P-2364360 . This is a "FIRST HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0746706 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 51774 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5269380 . This is a "CCN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 162142 . This is a "UNIVERSAL HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 260146000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 269348 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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