Provider Demographics
NPI:1578944823
Name:JAFFRI, NAZNEEN REHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAZNEEN
Middle Name:REHAN
Last Name:JAFFRI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W 50TH ST
Mailing Address - Street 2:APT# 6N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6664
Mailing Address - Country:US
Mailing Address - Phone:917-886-9048
Mailing Address - Fax:
Practice Address - Street 1:286 MADISON AVE STE 1000
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6381
Practice Address - Country:US
Practice Address - Phone:212-337-9571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0588751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008068762Medicaid