Provider Demographics
NPI:1629180450
Name:JAFFE, HARRY JAY (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:JAY
Last Name:JAFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 CENTRAL STREET
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1507
Mailing Address - Country:US
Mailing Address - Phone:847-475-8888
Mailing Address - Fax:847-869-2932
Practice Address - Street 1:1713 CENTRAL STREET
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1507
Practice Address - Country:US
Practice Address - Phone:847-475-8888
Practice Address - Fax:847-869-2932
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12889Medicare UPIN