Provider Demographics
NPI:1619171774
Name:SYED JAFRI
Entity Type:Organization
Organization Name:SYED JAFRI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOGRIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-477-3544
Mailing Address - Street 1:330 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3705
Mailing Address - Country:US
Mailing Address - Phone:212-684-7640
Mailing Address - Fax:212-684-7649
Practice Address - Street 1:330 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3705
Practice Address - Country:US
Practice Address - Phone:212-684-7640
Practice Address - Fax:212-684-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00211665Medicaid
NYB16650Medicare UPIN
NY00211665Medicaid