Provider Demographics
NPI:1255312120
Name:LEFF, JORDAN H (MD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:H
Last Name:LEFF
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 1:31 ROCHE BROTHERS WAY
Mailing Address - Street 2:TWO WASHINGTON PLACE
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1032
Mailing Address - Country:US
Mailing Address - Phone:508-894-8760
Mailing Address - Fax:508-894-8762
Practice Address - Street 1:31 ROCHE BROTHERS WAY
Practice Address - Street 2:TWO WASHINGTON PLACE
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1032
Practice Address - Country:US
Practice Address - Phone:508-894-8760
Practice Address - Fax:508-894-8762
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA52648208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6176534Medicaid
MA6176534Medicaid
J03409Medicare ID - Type Unspecified