MEDICARE: DR. JUDITH LIZA JAFFE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	131769	NY

General Provider Information

NPI Number	:	1053697581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH LIZA JAFFE M.D.

Provider Business Mailing Address
First Line	:	413 EAST 120TH STREET
Second Line	:	NYC DEPT OF SCHOOL HEALTH
City	:	NEW YORK
State	:	NY
Zip	:	10035-3602
Country	:	US
Telephone Number	:	917-492-6950
Fax Number	:	917-492-6972

Provider Business Practice Location Address
First Line	:	413 E 120TH ST
Second Line	:	NYC DEPT OF SCHOOL HEALTH
City	:	NEW YORK
State	:	NY
Zip	:	10035-3602
Country	:	US
Telephone Number	:	917-492-6950
Fax Number	:	917-492-6972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2011
Last Update Date	:	10/28/2011

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