Provider Demographics
NPI:1619007929
Name:JAFFE, MEREDITH B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:B
Last Name:JAFFE
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 1:9 MEDFORD LANE
Mailing Address - Street 2:
Mailing Address - City:E NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-5229
Mailing Address - Country:US
Mailing Address - Phone:631-368-1626
Mailing Address - Fax:
Practice Address - Street 1:7 HIGH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7605
Practice Address - Country:US
Practice Address - Phone:631-673-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041709122300000X
NY350219163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No163W00000XNursing Service ProvidersRegistered Nurse