Provider Demographics
NPI:1477794972
Name:S MOOSA JAFFARI MD PA
Entity Type:Organization
Organization Name:S MOOSA JAFFARI MD PA
Other - Org Name:MOOSA JAFFARI MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:S
Authorized Official - Middle Name:MOOSA
Authorized Official - Last Name:JAFFARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:732-367-7707
Mailing Address - Street 1:814 RIVER AVE.
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-367-7707
Mailing Address - Fax:732-367-7860
Practice Address - Street 1:814 RIVER AVE.
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701
Practice Address - Country:US
Practice Address - Phone:732-367-7707
Practice Address - Fax:732-367-7860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02930800207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC52947Medicare UPIN
NJJA72647Medicare PIN