MEDICARE: DR. IRA MITCHELL JAFFE D.O.

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	207V00000X	Obstetrics & Gynecology Physician	181778	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548274210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA MITCHELL JAFFE D.O.

Provider Business Mailing Address
First Line	:	6520 SPRING BROOK AVE
Second Line	:
City	:	RHINEBECK
State	:	NY
Zip	:	12572-3713
Country	:	US
Telephone Number	:	845-876-0526
Fax Number	:	845-876-7531

Provider Business Practice Location Address
First Line	:	6520 SPRING BROOK AVE
Second Line	:
City	:	RHINEBECK
State	:	NY
Zip	:	12572-3713
Country	:	US
Telephone Number	:	845-876-0526
Fax Number	:	845-876-7531

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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