Healthcare Provider Details

I. General information

NPI: 1366477440
Provider Name (Legal Business Name): JONATHAN J VAFAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 VIA DELRAY
DELRAY BEACH FL
33484-1315
US

IV. Provider business mailing address

5035 VIA DELRAY
DELRAY BEACH FL
33484-1315
US

V. Phone/Fax

Practice location:
  • Phone: 561-637-0500
  • Fax: 561-637-0055
Mailing address:
  • Phone: 561-637-0500
  • Fax: 561-637-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number227719
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA08750800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number244522
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME111174
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: