Provider Demographics
NPI:1659366318
Name:JAFFE, JOEL D (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:D
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 1:400 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1819
Mailing Address - Country:US
Mailing Address - Phone:215-750-7300
Mailing Address - Fax:215-750-7111
Practice Address - Street 1:400 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1819
Practice Address - Country:US
Practice Address - Phone:215-750-7300
Practice Address - Fax:215-750-7111
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018065E207Y00000X
NJ25MA04200600207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5642906Medicaid
PAJA118662Medicare ID - Type Unspecified
C30650Medicare UPIN