MEDICARE: MOHAMMED JAFFAR RN

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	163W00000X	Registered Nurse	623024	PA
2	163W00000X	Registered Nurse	629747	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700180338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMED JAFFAR RN

Provider Business Mailing Address
First Line	:	3308 HARTEL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3026
Country	:	US
Telephone Number	:	347-735-8375
Fax Number	:

Provider Business Practice Location Address
First Line	:	3308 HARTEL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3026
Country	:	US
Telephone Number	:	347-735-8375
Fax Number	:

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

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	09/22/2011

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