MEDICARE: DR. STACEY G JAFF 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	209959	NY
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	209959	NY
3	208100000X	Physical Medicine & Rehabilitation Physician	209959	NY

General Provider Information

NPI Number	:	1629071253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY G JAFF M.D.

Provider Business Mailing Address
First Line	:	PLAZA DEL CASTILLO HEALTH CENTER
Second Line	:	1515 SOUTHERN BOULEVARD
City	:	BRONX
State	:	NY
Zip	:	10460
Country	:	US
Telephone Number	:	718-589-2440
Fax Number	:

Provider Business Practice Location Address
First Line	:	PLAZA DEL CASTILLO HEALTH CENTER
Second Line	:	1515 SOUTHERN BOULEVARD
City	:	BRONX
State	:	NY
Zip	:	10460
Country	:	US
Telephone Number	:	718-589-2440
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/26/2019

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