Provider Demographics
NPI:1730148339
Name:JAFFE, STEPHEN HERBERT (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HERBERT
Last Name:JAFFE
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 1:401 S VAN BRUNT ST
Mailing Address - Street 2:STE 405
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4604
Mailing Address - Country:US
Mailing Address - Phone:201-871-4346
Mailing Address - Fax:201-871-0196
Practice Address - Street 1:401 S VAN BRUNT ST
Practice Address - Street 2:STE 405
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4604
Practice Address - Country:US
Practice Address - Phone:201-871-4346
Practice Address - Fax:201-871-0196
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA27378207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G83917Medicare UPIN
020551Medicare ID - Type Unspecified