Healthcare Provider Details

I. General information

NPI: 1427184829
Provider Name (Legal Business Name): SYED H JAFFERY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 E WATER ST
ELMIRA NY
14901-3332
US

IV. Provider business mailing address

700 WARREN RD APT # 24-1A
ITHACA NY
14850-1256
US

V. Phone/Fax

Practice location:
  • Phone: 607-733-5696
  • Fax:
Mailing address:
  • Phone: 607-319-4882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number248649
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: