Provider Demographics
NPI:1003877663
Name:JAFFERY, FATEMA (MD)
Entity Type:Individual
Prefix:DR
First Name:FATEMA
Middle Name:
Last Name:JAFFERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 RICHARD RD
Mailing Address - Street 2:PRIME PEDIATRICS
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2515
Mailing Address - Country:US
Mailing Address - Phone:973-373-9600
Mailing Address - Fax:973-373-2030
Practice Address - Street 1:50 UNION AVE
Practice Address - Street 2:SUITE 704
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3262
Practice Address - Country:US
Practice Address - Phone:973-373-9600
Practice Address - Fax:973-373-2030
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61576208000000X
NJ25MA061576002080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9022805Medicaid