Healthcare Provider Details

I. General information

NPI: 1497752976
Provider Name (Legal Business Name): JAY S JAFFESS PHARM.D, MS, BCPP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANGHORNE NEWTOWN RD
LANGHORNE PA
19047-1201
US

IV. Provider business mailing address

55 THOROUGHBRED DR
HOLLAND PA
18966-2571
US

V. Phone/Fax

Practice location:
  • Phone: 215-710-2069
  • Fax:
Mailing address:
  • Phone: 215-860-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRP039447R
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: