Healthcare Provider Details

I. General information

NPI: 1790744902
Provider Name (Legal Business Name): JAFFE FRIEDMAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S VAN BEUNT ST SUITE 405
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

PO BOX 34230
NEWARK NJ
07189-0230
US

V. Phone/Fax

Practice location:
  • Phone: 201-871-4346
  • Fax: 201-871-5953
Mailing address:
  • Phone: 201-871-4346
  • Fax: 201-871-5953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KERRY ANN STOKES
Title or Position: BILLING MGR
Credential:
Phone: 201-871-4346