1356795892 NPI number — JAFFE ADDICTION RECOVERY AND PAIN MANAGEMENT SERVICES

Table of content: (NPI 1356795892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356795892 NPI number — JAFFE ADDICTION RECOVERY AND PAIN MANAGEMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAFFE ADDICTION RECOVERY AND PAIN MANAGEMENT SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1356795892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8095 SPYGLASS HILL RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32940-8290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-757-0577
Provider Business Mailing Address Fax Number:
321-757-0474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8095 SPYGLASS HILL RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32940-8290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-757-0577
Provider Business Practice Location Address Fax Number:
321-757-0474
Provider Enumeration Date:
04/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
JAFFE
Authorized Official First Name:
TODD
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
321-757-0577

Provider Taxonomy Codes

  • Taxonomy code: 207LA0401X , with the licence number:  ME0039795 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: ME00396795 , 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)





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