Provider Demographics
NPI:1578949368
Name:DR SALEHA JAFAR MEDICAL PRACTICE PLLC
Entity Type:Organization
Organization Name:DR SALEHA JAFAR MEDICAL PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-505-5634
Mailing Address - Street 1:312 NORTH PLANK RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8858
Mailing Address - Country:US
Mailing Address - Phone:845-505-5634
Mailing Address - Fax:845-566-5674
Practice Address - Street 1:312 NORTH PLANK RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-8858
Practice Address - Country:US
Practice Address - Phone:845-505-5634
Practice Address - Fax:845-566-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY858821OtherMEDICARE ID
NY02251018Medicaid
NY858821OtherMEDICARE ID