Healthcare Provider Details

I. General information

NPI: 1659366318
Provider Name (Legal Business Name): JOEL D. JAFFE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MIDDLETOWN BLVD SUITE 100
LANGHORNE PA
19047-1819
US

IV. Provider business mailing address

400 MIDDLETOWN BLVD SUITE 100
LANGHORNE PA
19047-1819
US

V. Phone/Fax

Practice location:
  • Phone: 215-750-7300
  • Fax: 215-750-7111
Mailing address:
  • Phone: 215-750-7300
  • Fax: 215-750-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD018065E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA04200600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: