Provider Demographics
NPI:1861427106
Name:JAFFE, ADAM DAVID
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DAVID
Last Name:JAFFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MAIN ST
Mailing Address - Street 2:POB 310
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-0310
Mailing Address - Country:US
Mailing Address - Phone:315-386-8811
Mailing Address - Fax:
Practice Address - Street 1:123 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-0310
Practice Address - Country:US
Practice Address - Phone:315-386-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV04631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0304570001OtherMEDICARE DME SUPPLIER
T26747Medicare UPIN
NY50971BMedicare ID - Type Unspecified