Provider Demographics
NPI:1295037786
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:PHYSICIAN
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 DR
Mailing Address - Street 2:SUITE 134
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1141
Mailing Address - Country:US
Mailing Address - Phone:561-439-0308
Mailing Address - Fax:561-439-6252
Practice Address - Street 1:130 JFK DR
Practice Address - Street 2:SUITE 134
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1141
Practice Address - Country:US
Practice Address - Phone:561-439-0308
Practice Address - Fax:561-439-6252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty