Provider Demographics
NPI:1366477440
Name:VAFAI, JONATHAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:J
Last Name:VAFAI
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 1:5035 VIA DELRAY
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1315
Mailing Address - Country:US
Mailing Address - Phone:561-637-0500
Mailing Address - Fax:561-637-0055
Practice Address - Street 1:5035 VIA DELRAY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-1315
Practice Address - Country:US
Practice Address - Phone:561-637-0500
Practice Address - Fax:561-637-0055
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227719207R00000X
NJ25MA08750800207RC0000X
NY244522207RC0000X
FLME111174207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14H87OtherBC/BS FLORIDA
FLNOT APPLICABLEMedicare UPIN
FLFN164ZMedicare PIN