1740290147 NPI number — SAATIAH JAFFRY M.D.

Table of content: SAATIAH JAFFRY M.D. (NPI 1740290147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740290147 NPI number — SAATIAH JAFFRY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAFFRY
Provider First Name:
SAATIAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1740290147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 781737
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEBASTIAN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32978-1737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-643-4371
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7965 BAY ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
SEBASTIAN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32958-3282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-918-8487
Provider Business Practice Location Address Fax Number:
772-918-8621
Provider Enumeration Date:
08/08/2006

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: 207RN0300X , with the licence number:  ME107571 , 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: 3900213 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00920765 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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