Provider Demographics
NPI:1629299540
Name:JAFFE, MARC PETER (DC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:PETER
Last Name:JAFFE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SOUTH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1364
Mailing Address - Country:US
Mailing Address - Phone:908-288-7049
Mailing Address - Fax:908-522-0523
Practice Address - Street 1:313 SOUTH AVE STE 205
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1364
Practice Address - Country:US
Practice Address - Phone:908-288-7049
Practice Address - Fax:908-522-0523
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00302200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
176767Medicare ID - Type Unspecified