Healthcare Provider Details

I. General information

NPI: 1619007929
Provider Name (Legal Business Name): MEREDITH B JAFFE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 HIGH ST SUITE 209
HUNTINGTON NY
11743-7605
US

IV. Provider business mailing address

9 MEDFORD LANE
E NORTHPORT NY
11731-5229
US

V. Phone/Fax

Practice location:
  • Phone: 631-673-8061
  • Fax:
Mailing address:
  • Phone: 631-368-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number041709
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number350219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: