Provider Demographics
NPI:1659484210
Name:JAFFE, EDITH (MD)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:JAFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CORPORATE WOODS
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1472
Mailing Address - Country:US
Mailing Address - Phone:585-276-7575
Mailing Address - Fax:585-426-0976
Practice Address - Street 1:2135 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1507
Practice Address - Country:US
Practice Address - Phone:585-276-7575
Practice Address - Fax:585-276-7574
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02377824Medicaid
NY02377824Medicaid
NYJ400100489Medicare PIN
NY70006A/J400088694Medicare PIN
NYRB5679Medicare PIN