Provider Demographics
NPI:1528068830
Name:SCHIFFMAN, JONATHAN S (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:SCHIFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4614
Mailing Address - Country:US
Mailing Address - Phone:973-472-0365
Mailing Address - Fax:973-472-1007
Practice Address - Street 1:192 HIGH ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4614
Practice Address - Country:US
Practice Address - Phone:973-472-0365
Practice Address - Fax:973-472-1007
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06830300208000000X, 2080P0203X
NY219512208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8284202Medicaid
H23628Medicare UPIN
NJ8284202Medicaid