Healthcare Provider Details

I. General information

NPI: 1376761643
Provider Name (Legal Business Name): STEPHEN H. JAFFE, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S VAN BRUNT ST SUITE 405
ENGLEWOOD NJ
07631-4604
US

IV. Provider business mailing address

PO BOX 34230
NEWARK NJ
07189-0001
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 Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License NumberMA27378
License Number StateNJ

VIII. Authorized Official

Name: KERRY A STOKES
Title or Position: BILLING MGR
Credential:
Phone: 201-871-0740