Provider Demographics
NPI:1548274210
Name:JAFFE, IRA MITCHELL (DO)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:MITCHELL
Last Name:JAFFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 SPRING BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-3713
Mailing Address - Country:US
Mailing Address - Phone:845-876-0526
Mailing Address - Fax:845-876-7531
Practice Address - Street 1:6520 SPRING BROOK AVE
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-3713
Practice Address - Country:US
Practice Address - Phone:845-876-0526
Practice Address - Fax:845-876-7531
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181778207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01348618Medicaid
NY86K37Medicare ID - Type Unspecified
NY01348618Medicaid