Provider Demographics
NPI:1235326471
Name:KENNETH S JAFFE MD PA
Entity Type:Organization
Organization Name:KENNETH S JAFFE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-439-0308
Mailing Address - Street 1:130 JFK DRIVE
Mailing Address - Street 2:SUITE 134
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462
Mailing Address - Country:US
Mailing Address - Phone:561-439-0308
Mailing Address - Fax:561-439-0371
Practice Address - Street 1:130 JOHN F KENNEDY DRIVE
Practice Address - Street 2:SUITE 134
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462
Practice Address - Country:US
Practice Address - Phone:561-439-0308
Practice Address - Fax:561-439-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269348OtherAVMED
FL110233181OtherRAILROAD MEDICARE
FL260146000Medicaid
FL97340OtherBCBSFL
FL260146000Medicaid
FL269348OtherAVMED