Healthcare Provider Details

I. General information

NPI: 1396958724
Provider Name (Legal Business Name): DR. MARK H. JAFFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S WASHINGTON AVE
BERGENFIELD NJ
07621-4323
US

IV. Provider business mailing address

375 S WASHINGTON AVE
BERGENFIELD NJ
07621-4323
US

V. Phone/Fax

Practice location:
  • Phone: 201-385-0775
  • Fax: 201-385-5375
Mailing address:
  • Phone: 201-385-0775
  • Fax: 201-385-5375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number10797
License Number StateNJ

VIII. Authorized Official

Name: MARK HARRIS JAFFE
Title or Position: DIRECTOR
Credential:
Phone: 201-385-0775