Provider Demographics
NPI:1285683185
Name:JAFFEE OPHTHALMOLOGY, PLLC
Entity Type:Organization
Organization Name:JAFFEE OPHTHALMOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:JAFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-692-3937
Mailing Address - Street 1:1 RYKOWSKI LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4019
Mailing Address - Country:US
Mailing Address - Phone:845-692-3937
Mailing Address - Fax:845-692-5259
Practice Address - Street 1:1 RYKOWSKI LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4019
Practice Address - Country:US
Practice Address - Phone:845-692-3937
Practice Address - Fax:845-692-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130811174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00804559Medicaid
NY5601520001Medicare NSC
NYCBWMV1Medicare PIN
NYC08556Medicare UPIN