1376761643 NPI number — STEPHEN H. JAFFE, MD, LLC

Table of content: (NPI 1376761643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376761643 NPI number — STEPHEN H. JAFFE, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN H. JAFFE, MD, LLC
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:
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:
1376761643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07189-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-871-4346
Provider Business Mailing Address Fax Number:
201-871-5953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 S VAN BRUNT ST
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-871-4346
Provider Business Practice Location Address Fax Number:
201-871-5953
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STOKES
Authorized Official First Name:
KERRY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BILLING MGR
Authorized Official Telephone Number:
201-871-0740

Provider Taxonomy Codes

  • Taxonomy code: 207VH0002X , with the licence number:  MA27378 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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