=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649451832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREDRICK F. JAFFE, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2007
-----------------------------------------------------
Last Update Date | 11/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 E 17TH ST SUITE 213
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-3804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-598-7605
-----------------------------------------------------
Fax | 212-598-7609
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 E 17TH ST SUITE 213
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-3804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-598-7605
-----------------------------------------------------
Fax | 212-598-7609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. FREDRICK FRANCIS JAFFE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-598-7605
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0114X
-----------------------------------------------------
Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 104356
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------