Healthcare Provider Details

I. General information

NPI: 1346967999
Provider Name (Legal Business Name): JACK JAY REIFFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MASSACHUSETTS AVE NW APT 514
WASHINGTON DC
20005-1826
US

IV. Provider business mailing address

1500 MASSACHUSETTS AVE NW APT 514
WASHINGTON DC
20005-1826
US

V. Phone/Fax

Practice location:
  • Phone: 202-230-1481
  • Fax:
Mailing address:
  • Phone: 202-230-1481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: