1871588780 NPI number — REBECCA JAFFE AND ASSOCIATES PA

Table of content: (NPI 1871588780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871588780 NPI number — REBECCA JAFFE AND ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REBECCA JAFFE AND ASSOCIATES PA
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:
1871588780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3105 LIMESTONE RD STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19808-2156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-992-0200
Provider Business Mailing Address Fax Number:
302-992-9282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3105 LIMESTONE RD STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19808-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-992-0200
Provider Business Practice Location Address Fax Number:
302-992-9282
Provider Enumeration Date:
09/16/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE/BILLING SUPERVISOR
Authorized Official Telephone Number:
302-992-0200

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  975464163 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 510279425 . This is a "BLUE CROSS BLUE SHIELD DE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000210202 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78517 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".