Healthcare Provider Details

I. General information

NPI: 1023289378
Provider Name (Legal Business Name): JONATHAN DOUGLAS JAFFE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J. DOUGLAS JAFFE D.O., R.N.

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MADISON AVE FL 1
MOUNT HOLLY NJ
08060-2099
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 609-914-6000
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2010-01825
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2010-01825
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MB12389900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: